Chemical composition and biological activities of essential oil from Grewia bulot leaves.

This study focused on the chemical composition and biological activities of the essential oil derived from Grewia bulot, a plant species known for its medicinal properties. The analysis of Grewia bulot essential oil revealed the presence of 78 constituents. The major compounds were α-cadinol (13.5%), 1,8-cineole (12.7%), 1,10-di-epi-cubenol (9.8%), epi-α-cadinol (6.7%), (E,E)-α-farnesene (5.9%), (E)-citral (4.0%), selin-11-en-4-α-ol (4.0%), citronellol isobutanoate (3.9%), and geranic acid (3.7%). The essential oil exhibited promising antioxidant potential with an IC50 value of 452.65 ± 28.40 µg/mL in DPPH model. This oil did not show NO production inhibitory effect in RAW 264.7 cells. In addition, the essential oil exhibited significant cytotoxicity against KB, Hep-G2, MCF-7, and SK-LU-1 cancer cell lines, with IC50 values ranging from 44.04 ± 1.47 to 74.20 ± 3.71 µg/mL.

Prevalence and Associated Factors of optrA-Positive-Enterococcus faecalis in Different Reservoirs around Farms in Vietnam.

Linezolid is an antibiotic of last resort for the treatment of infections caused by Gram-positive bacteria, including vancomycin-resistant enterococci. Enterococcus faecalis, a member of enterococci, is a significant pathogen in nosocomial infections. E. faecalis resistance to linezolid is frequently related to the presence of optrA, which is often co-carried with fex, phenicol exporter genes, and erm genes encoding macrolide resistance. Therefore, the common use of antibiotics in veterinary might promote the occurrence of optrA in livestock settings. This is a cross-sectional study aiming to investigate the prevalence of optrA positive E. faecalis (OPEfs) in 6 reservoirs in farms in Ha Nam province, Vietnam, and its associated factors and to explore genetic relationships of OPEfs isolates. Among 639 collected samples, the prevalence of OPEfs was highest in flies, 46.8% (51/109), followed by chickens 37.3% (72/193), dogs 33.3% (17/51), humans 18.7% (26/139), wastewater 16.4% (11/67) and pigs 11.3%, (14/80). The total feeding area and total livestock unit of the farm were associated with the presence of OPEfs in chickens, flies, and wastewater. Among 186 OPEfs strains, 86% were resistant to linezolid. The presence of optrA was also related to the resistant phenotype against linezolid and levofloxacin of E. faecalis isolates. Close genotypic relationships identified by Pulsed Field Gel Electrophoresis between OPEfs isolates recovered from flies and other reservoirs including chickens, pigs, dogs, and wastewater suggested the role of flies in the transmission of antibiotic-resistant pathogens. These results provided warnings of linezolid resistance although it is not used in livestock.

A new spirostanol steroid and a new spirostanol steroidal saponin from Aspidistra triradiata and their cytotoxic activities.

A new spirostanol steroid, aspidiata A (1), and a new spirostanol steroidal saponin, aspidiata B (2), along with three known compounds, paris saponin VII (3), daucosterol (4), and (25R)-spirostane-1ß,2ß,3ß,4ß,5ß,6ß-hexol (5), were isolated from whole plants of Aspidistra triradiata collected in Vietnam. Their chemical structures were established by spectroscopic analysis and comparison with previously published data. Compound 3 showed strong cytotoxicity against LU-1, Hep-G2, MCF-7, and KB human cancer cell lines with half maximal inhibitory concentration (IC50) values ranging from 0.57 to 1.23 µM. Compound 5 exhibited weak cytotoxic activity against the LU-1 cell line, with an IC50 value of 95.81 µM.

Hydrothermal carbonization of food waste as sustainable energy conversion path.

Every day, a large amount of food waste (FW) is released into the environment, causing financial loss and unpredictable consequences in the world, highlighting the urgency of finding a suitable approach to treating FW. As moisture content makes up 75% of the FW, hydrothermal carbonization (HTC) is a beneficial process for the treatment of FW since it does not require extensive drying. Moreover, the process is considered favorable for carbon sequestration to mitigate climate change in comparison with other processes because the majority of the carbon in FW is integrated into hydrochar. In this work, the reaction mechanism and factors affecting the HTC of FW are scrutinized. Moreover, the physicochemical properties of products after the HTC of FW are critically presented. In general, HTC of FW is considered a promising approach aiming to attain simultaneously-two core benefits on economy and energy in the sustainable development strategy.

High electrochemical performance of ink solution based on manganese cobalt sulfide/reduced graphene oxide nano-composites for supercapacitor electrode materials.

Large scale supercapacitor electrodes were prepared by 3D-printing directly on a graphite paper substrate from ink solution containing manganese cobalt sulfide/reduced graphene oxide (MCS/rGO) nanocomposites. The MCS/rGO composite solution was synthesized through the dispersion of MCS NPs and rGO in dimethylformamide (DMF) solvent at room temperature. Their morphology and composition were investigated by scanning electron microscopy (SEM), transmission electron microscopy (TEM), and energy dispersive X-ray diffraction (EDS). The role of rGO on decreasing charge transfer resistance and enhancing ion exchange was discussed. The MCS/rGO electrode exhibits an excellent specific capacitance of 3812.5 F g-1 at 2 A g-1 and it maintains 1780.8 F g-1 at a high current density of 50 A g-1. The cycling stability of the electrodes reveals capacitance retention of over 92% after 22 000 cycles at 50 A g-1.

Anal human papillomavirus prevalence and risk factors among men who have sex with men in Vietnam.

OBJECTIVES: Men who have sex with men (MSM) are at risk of human papillomavirus (HPV)-related cancers, while published data are scarce. This study determined HPV prevalence and risk factors in MSM in Vietnam to inform HPV prevention strategies in this key population. METHODS: A cross-sectional study of 799 MSM aged 16-50 years was conducted in Vietnam in 2017-2018. Information was collected on risk behaviours, and knowledge of HPV and anal cancer; rectal swabs were taken to detect anal HPV infection. An in-house polymerase chain reaction and Genoflow HPV array test kit were used for HPV detection and genotyping. RESULTS: The median age of the study participants was 25 years (range 18-52). Overall prevalence of any HPV and HPV16/18 infection was 32.3% and 11.0%, respectively. A higher prevalence of high-risk HPV infection to all 14 types tested was found in Ho Chi Minh City (30.9%) than in Hanoi (18.4%). High-risk HPV infection was associated with inconsistent condom use and history of engaging in sex under the influence of drugs (adjusted odds ratio (aOR), 2.27; 95% CI, 1.48-10.67), as well as having multiple sexual partners (aOR, 1.01; 95% CI, 1.00-1.02). CONCLUSIONS: High-risk anal HPV infections in Vietnamese MSM were significantly associated with risky sexual behaviours. A targeted HPV vaccination strategy would have substantial benefit for MSM in Vietnam.

Effect of the social distancing measures on the spread of COVID-19 in 10 highly infected countries.

From the end of 2019, an unprecedented novel coronavirus, which was named COVID-19 by the World Health Organization (WHO) emerged from Wuhan city, China. Despite rigorous global containment and quarantine efforts, the incidence of COVID-19 has continued to rise, with over 4 million confirmed-cases and over 300,000 deaths worldwide until mid-May. This study aims to present the effect of the promulgation of social distancing measures on the spread of COVID-19 in the cases of 10 highly infected countries. The authors focus on the statistics of the COVID-19 confirmed-cases and deaths in 10 highly infected countries, including The U.S., Spain, Italy, The U.K., France, Germany, Russia, Turkey, Iran and China, and the response to the pandemic of these countries in the period from January 11 to May 2, 2020. The relationships between the social distancing measures and the statistics of COVID-19 confirmed-cases and deaths were analyzed in order to elucidate the effectiveness of the social distancing measures on the spread of COVID-19 in 10 highly infected countries. The results showed it took1-4 weeks since the highest level of social distancing measures promulgation until the daily confirmed-cases and deaths showed signs of decreasing. The effectiveness of the social distancing measures on the spread of COVID-19 was different between the 10 focused countries. This variation is due to the difference in the levels of promulgated social distancing measures, as well as the difference in the COVID-19 spread situation at the time of promulgation between the countries.

Phytochemical Compositions and Biological Activities of Essential Oils from the Leaves, Rhizomes and Whole Plant of Hornstedtia bella Skornick.

The rapid emergence of drug-resistant strains and novel viruses have motivated the search for new anti-infectious agents. In this study, the chemical compositions and cytotoxicity, as well as the antibacterial, antifungal, antitrichomonas, and antiviral activities of essential oils from the leaves, rhizomes, and whole plant of Hornstedtia bella were investigated. The GC/MS analysis showed that ß-pinene, E-ß-caryophyllene, and α-humulene were found at high concentrations in the essential oils. The essential oils exhibited (i) inhibition against Staphylococcus aureus, methicillin-resistant Staphylococcus aureus, Staphylococcus epidermidis with minimum inhibitory concentrations (MIC) and minimum lethal concentration (MLC) values from 1 to 4% (v/v); (ii) MIC and MLC values from 2 to 16% (v/v) in Candida tropicalis and Candida parapsilosis; (iii) MIC and MLC values from 4 to 16% in Enterococcus faecalis; and (iv) MIC and MLC values from 8 to greater than or equal to 16% (v/v) in the remaining strains, including Escherichia coli, Pseudomonas aeruginosa, Klebsiella pneumoniae, Candida albicans, and Candida glabrata. In antitrichomonas activity, the leaves and whole-plant oils of Hornstedtia bella possessed IC50, IC90, and MLC values of 0.008%, 0.016%, and 0.03% (v/v), respectively, whilst those of rhizomes oil had in turn, 0.004%, 0.008%, and 0.016% (v/v).Besides, the leaf oil showed a weak cytotoxicity against Vero 76 and MRC-5; meanwhile, rhizomes and whole-plant oils did not exert any toxic effects on cell monolayers. Finally, these oils were not active against EV-A71.

Number of People who Inject Drugs in Son La, Vietnam: Population Size Estimation Based on Official Records.

AIMS: Estimated population sizes of key populations are critical for resource allocation as well as for monitoring program performance to prevent HIV infection. In 2018, using official records we recruited and conducted a brief survey among People Who Use Drugs (PWUD) to estimate the population size of People Who Inject Drugs (PWID) in Son La Province, Vietnam. METHODS: In Son La, the authorities develop and maintain a master list of individuals who are suspected of using drugs. The list is updated quarterly and is used to monitor the drug use situation in the province. The list, however, does not distinguish injecting from non-injecting drug users. Individual lists from six districts, 24 communes, and 96 hamlets were selected from among those from 12 districts, 204 communes, and 3335 hamlets in the whole province. After reviewing the lists with the hamlet health workers, based on the length of the lists, a minimum of 20% of the total or five drug users in any hamlet with fewer than 25 PWUD were randomly selected for a brief assessment. In addition to basic demographics, the assessment included any drug use in the last 3 months, injection drug use in the last 3 months, and the last time injected. RESULTS: A total of 250 PWUD were interviewed by hamlet health workers. The total number of PWID across all 12 districts in Son La was estimated at 4475 [95% Confidence Interval (CI): 3379-5570] and the corresponding proportion of PWID among PWUD was 48.4% (95% CI: 36.6-60.4). CONCLUSION: The exercise provided an estimated number of PWID in Son La. For planning HIV prevention and care service needs among PWID, additional studies using different methods are needed to validate and improve the population size of PWID in the province of Son La.

In vitro Antimicrobial Activity of Essential Oil Extracted from Leaves of Leoheo domatiophorus Chaowasku, D.T. Ngo and H.T. Le in Vietnam.

:The present study aimed to determine the antimicrobial activity and chemical composition of leaves-extracted essential oil of Leoheo domatiophorus Chaowasku, D.T. Ngo and H.T. Le (L. domatiophorus), including antibacterial, antimycotic, antitrichomonas and antiviral effects. The essential oil was obtained using hydrodistillation, with an average yield of 0.34 ± 0.01% (v/w, dry leaves). There were 52 constituents as identified by GC/MS with available authentic standards, representing 96.74% of the entire leaves oil. The essential oil was comprised of three main components, namely viridiflorene (16.47%), (-)-δ-cadinene(15.58%) and γ-muurolene (8.00%). The oil showed good antimicrobial activities against several species: Gram-positive strains: Staphylococcus aureus (two strains) and Enterococcus faecalis, with Minimum Inhibitory Concentration (MIC) and Minimum Lethal Concentration (MLC) values from 0.25 to 1% (v/v); Gram-negative strains such as Escherichia coli (two strains), Pseudomonas aeruginosa (two strains) and Klebsiella pneumoniae, with MIC and MLC values between 2% and 8% (v/v); and finally Candida species, having MIC and MLC between 0.12 and 4% (v/v).Antitrichomonas activity of the oil was also undertaken, showing IC50, IC90 and MLC values of 0.008%, 0.016% and 0.03% (v/v), respectively, after 48h of incubation. The essential oil resultedin being completely ineffective against tested viruses, ssRNA+ (HIV-1, YFV, BVDV, Sb-1, CV-B4), ssRNA- (hRSVA2, VSV), dsRNA (Reo-1), and dsDNA (HSV-1, VV) viruses with EC50 values over 100 µg/mL. This is the first, yet comprehensive, scientific report about the chemical composition and pharmacological properties of the essential oil in L. domatiophorus.

Biological Activities of Essential Oils from Leaves of Paramignya trimera (Oliv.) Guillaum and Limnocitrus littoralis (Miq.) Swingle.

The present study aimed to determine the bioactivities of essential oils extracted from the leaves of Paramignya trimera and Limnocitrus littoralis, including cytotoxicity, antiviral, antibacterial, antimycotic, and antitrichomonas effects. Herein, it was indicated that P. trimera and L. littoralis oils showed no cytotoxicity on normal cells, namely MT-4, BHK-21, MDBK, and Vero-76. P. trimera oil (i) exhibited the strongest inhibition against Staphylococcus aureus with MIC and MLC values of 2% (v/v); (ii) showed MIC and MLC values of 8% (v/v) in Candida parapsilosis; and (iii) in the remaining strains, showed MIC and MLC values greater than or equal to 16% (v/v). On the other hand, L. littoralis oil (i) displayed the strongest inhibition against Candida tropicalis and Candida parapsilosis with 2% (v/v) of MIC and MLC; and (ii) in the remaining strains, possessed MIC and MLC greater than or equal to 16% (v/v). In addition, antitrichomonas activities of the oils were undertaken, showing IC50, IC90, MLC values, respectively, at 0.016%, 0.03%, and 0.06% (v/v) from P. trimera, and 0.03%, 0.06%, 0.12% (v/v) from L. littoralis, after 48 h of incubation. The oils were completely ineffective against ssRNA+ (HIV-1, YFV, BVDV, Sb-1, CV-B4), ssRNA- (RSV, VSV), dsRNA (Reo-1), and dsDNA (HSV-1, VV) viruses. This is the first report describing the cytotoxicity, antiviral, antibacterial, antimycotic, and antitrichomonas activities of the essential oils of P. trimera and L. littoralis.

Characterization of Solanum melongena Thioesterases Related to Tomato Methylketone Synthase 2.

2-Methylketones are involved in plant defense and fragrance and have industrial applications as flavor additives and for biofuel production. We isolated three genes from the crop plant Solanum melongena (eggplant) and investigated these as candidates for methylketone production. The wild tomato methylketone synthase 2 (ShMKS2), which hydrolyzes ß-ketoacyl-acyl carrier proteins (ACP) to release ß-ketoacids in the penultimate step of methylketone synthesis, was used as a query to identify three homologs from S. melongena: SmMKS2-1, SmMKS2-2, and SmMKS2-3. Expression and functional characterization of SmMKS2s in E. coli showed that SmMKS2-1 and SmMKS2-2 exhibited the thioesterase activity against different ß-ketoacyl-ACP substrates to generate the corresponding saturated and unsaturated ß-ketoacids, which can undergo decarboxylation to form their respective 2-methylketone products, whereas SmMKS2-3 showed no activity. SmMKS2-1 was expressed at high level in leaves, stems, roots, flowers, and fruits, whereas expression of SmMKS2-2 and SmMKS2-3 was mainly in flowers and fruits, respectively. Expression of SmMKS2-1 was induced in leaves by mechanical wounding, and by methyl jasmonate or methyl salicylate, but SmMKS2-2 and SmMKS2-3 genes were not induced. SmMKS2-1 is a candidate for methylketone-based defense in eggplant, and both SmMKS2-1 and SmMKS2-2 are novel MKS2 enzymes for biosynthesis of methylketones as feedstocks to biofuel production.

Efficacy of Communication Training of Community Health Workers on Service Delivery to People Who Inject Drugs in Vietnam: A Clustered Randomized Trial.

OBJECTIVES: To evaluate the efficacy of an intervention targeted to commune health workers (CHWs) who deliver services to people who inject drugs (PWID) in Vietnam. METHODS: From 2014 to 2016, we conducted a cluster randomized controlled trial of 300 CHWs and 900 PWID in 60 communes in 2 provinces of Vietnam. Intervention CHWs participated in training sessions to enhance their communication skills. Trained CHWs were asked to deliver individual sessions to PWID. We assessed the outcomes at baseline and at 3-, 6-, 9-, and 12-month follow-ups. RESULTS: Intervention CHWs showed greater improvement in provider-client interactions than did control CHWs at all follow-ups (range of difference = 3.33-5.18; P < .001). Intervention CHWs showed greater reduction in negative attitudes toward PWID at the 12-month follow-up (mean ±SD = 1.75 ±0.50; P < .001). PWID in the intervention group exhibited greater improvement in drug avoidance than did those in the control group from the 6-month follow-up on (range of difference = 1.21-1.65; P < .001). We observed no intervention effect on heroin use as measured by urinalysis. CONCLUSIONS: This intervention targeting CHWs could lead to desired outcomes for both CHWs and PWID. ClinicalTrials.gov: NCT0213092.1.

Alcohol Use, HIV Treatment Adherence, and Sexual Risk Among People with a History of Injecting Drug Use in Vietnam.

Alcohol use can limit the effectiveness of antiretroviral therapy (ART) for people living with HIV (PLH) who have a history of injecting drug use. This study described the patterns of alcohol use among PLH with a history of injecting drug use in Vietnam and examined the relationships between alcohol use, adherence to ART, and sexual risks. We utilized cross-sectional data of 109 PLH on ART collected from a randomized controlled intervention trial in Vietnam. Approximately 30 and 46% of the participants were frequent and occasional drinkers, respectively. Frequent drinkers reported the highest number of missed medication days. About 61% of frequent drinkers reported having sex after using alcohol. Additionally, 23, 34, and 24% of nondrinkers, occasional drinkers, and frequent drinkers, respectively, reported inconsistent condom use during sex. Future intervention programs should address the issues of alcohol use and sexual risks to maximize the effectiveness of HIV treatment programs in Vietnam.

Antiretroviral therapy adherence and self-efficacy among people living with HIV and a history of drug use in Vietnam.

People living with HIV with a history of drug use face additional psychosocial challenges that could compromise their adherence to antiretroviral therapy (ART). This study examined ART treatment adherence and adherence self-efficacy among people living with HIV with a history of drug use in Vietnam. We used cross-sectional baseline data collected between October 2014 and February 2015 from a randomized controlled trial in Vietnam. Of the 900 persons with a history of drug use in the trial, a sample of 109 people living with HIV currently on ART were included in the study. The vast majority (92%) of the participants reported not missing any medications in the past 30 days. Multiple regression results indicated that social support was positively associated with adherence self-efficacy (ß = 0.420, P < 0.001) and general adherence to ART (ß = 0.201, P = 0.0368). General adherence to ART was negatively associated with depressive symptoms (ß = -0.188, P = 0.046) and current heroin use (ß = -0.196, P = 0.042). These findings underscore the importance of addressing mental health and social challenges facing people living with HIV with a history of drug use to promote ART treatment adherence. Clinical management of HIV should identify and address concurrent substance use behaviors to maximize adherence and treatment outcomes.

Progressive cutaneous Cryptococcosis complicated with meningitis in a myasthenia gravis patient on long-term immunosuppressive therapy - a case report.

BACKGROUND: Cryptococcosis is an opportunistic infection caused by the encapsulated yeast Cryptococcus neoformans and most remarkably manifests in HIV-infected individuals, especially in the settings of very low CD4 count. Development of cryptococcosis in HIV-uninfected individuals is exceedingly rare and usually signifies a marked immunodeficiency. Cryptococcosis in association with myasthenia gravis or thymoma has been previously documented in only very few cases in the literature. CASE PRESENTATION: We reported a complicated case of severe cutaneous cryptococcosis in a 39-year-old Vietnamese male patient with myasthenia gravis on long-term immunosuppressive therapy. The patient presented with a five month history of recurrent and progressive skin lesions that later on progressed into cryptococcal meningitis. CONCLUSION: Through this case, we aimed to emphasize the importance of including cutaneous cryptococcosis in the differential diagnosis of cutaneous lesions in patients on chronic immunosuppressive therapy. The cutaneous manifestations of cryptococcosis can be the first clue for a disseminated disease, which makes early recognition crucial and life-saving.

Brief behavioural surveys in routine HIV sentinel surveillance: a new tool for monitoring the HIV epidemic in Viet Nam.

In this report we describe a new approach in HIV sentinel surveillance that was piloted in Viet Nam in 2009 and is currently being rolled out in all provinces. It comprises a brief behavioural questionnaire added to the HIV sentinel surveillance surveys conducted routinely among people who inject drugs, female sex workers and men who have sex with men. Timely reporting of data from this system has resulted in improvements to HIV prevention efforts for most at-risk populations.

Challenges facing HIV-positive persons who use drugs and their families in Vietnam.

It is hypothesized that persons who use drugs (PWUD) in Vietnam who are also HIV-positive may face additional challenges in psychosocial outcomes, and these challenges may extend to their family members. In this study, we examined depressive symptoms, stigma, social support, and caregiver burden of HIV-positive PWUD and their family members, compared to the outcomes of HIV-negative PWUD and their family members. Baseline, 3-month, and 6-month assessment data were gathered from 83 PWUD and 83 family members recruited from four communes in Phú Tho Province, Vietnam. For PWUD, although we observed a general decline in overall stigma over time for both groups, HIV-positive PWUD consistently reported significantly higher overall stigma for all three periods. Depressive symptoms among family members in both groups declined over time; however, family members of HIV-positive PWUD reported higher depressive symptoms across all three periods. In addition, family members of HIV-positive PWUD reported lower levels of tangible support across all three periods. Caregiver burden among family members of HIV-positive PWUD increased significantly over time, whereas the reported burden among family members of HIV-negative PWUD remained relatively unchanged. The findings highlight the need for future interventions for PWUD and family members, with targeted and culturally specific strategies to focus on the importance of addressing additional stigma experienced by PWUD who are HIV-positive. Such challenges may have direct negative impact on their family members' depressive symptoms, tangible support, and caregiver burden.

An intervention to improve mental health and family well-being of injecting drug users and family members in Vietnam.

Family plays an important role in the lives of injecting drug users (IDUs) in Vietnam. This study examined the preliminary outcomes of an intervention targeting IDUs and their family members in Vietnam. Eighty-three families, including 83 IDUs and 83 family members, were recruited from 4 communes in Phú Tho Province, Vietnam. The 4 communes were randomized to either an intervention condition or a standard care condition. The IDUs and their family members in the intervention condition completed 4 group sessions, with the aims to improve their mental health and family relations and to promote positive behavioral change. The intervention effect was evaluated at baseline and 3- and 6-month follow-up assessments. A significant reduction in depressive symptoms and improvement in family functioning were reported for IDUs in the intervention group compared with those in the standard care group. The family members in the intervention group reported better coping skills at 3 months, fewer depressive symptoms at 6 months, and improved family function at both 3 and 6 months compared with those in the standard care group. However, no significant intervention effect was observed for IDUs in terms of drug-using behavior. This study demonstrates the feasibility and preliminary outcomes of an intervention that simultaneously targets IDUs and their family members in Vietnam. Study findings highlight the importance of including family members and enhancing their role in drug use intervention efforts.

Maternal and fetal mortality and complications associated with cesarean section deliveries in teaching hospitals in Asia.

AIM: To compare the mortality, morbidity of emergency and elective cesarean section with vaginal delivery among Asian teaching hospitals. METHODS: Hospital based prospective study at 12 centers of 9 countries. RESULTS: 12 591 vaginal deliveries, 3062 elective and 4328 emergency cesarean section were followed up to 5 days postpartum. Maternal deaths (95% CI) per 1000 births among vaginal deliveries being 0.47 (0.17, 1.03) was not significantly different from 0.31 (0.01, 1.73) of elective cesarean section and both rates were significantly lower than 2.87 (1.53, 4.91) per 1000 births of emergency section. The vaginal delivery group had significantly lower incidences of all major complication except significantly higher chance of secondary operations and non-significantly different risk for endometritis. Corresponding neonatal mortality per 1000 deliveries among the three groups were 7 (5.6, 8.6), 2.2 (0.9, 4.6) and 12.4 (9.3, 16.2) (P < 0.001). Vaginal delivery also had higher rates of severe asphyxia and palsy than elective cesarean section. CONCLUSION: Maternal complications were increased by cesarean delivery but elective section may reduce neonatal complication.