2.Denovillier’s fascia separates
Vagina from rectum
Descending colon from the ureters
Prostate frpm the rectum
Rectum for the sacrum

3.In lateral anal sphincterotomy, the following sphincter is divided
Subcutaneous part of external sphinter
Deep part of external sphincter
Internal sphincter
Puorectalis spincter

4.Klatskin tumour involves
Intrahepatic bile duct
Hepatic duct confluence
Lower 1/3 bile duct
Periampullary area

5.T.B.Adenitis usually involves the
Submaxillary nodes
Jugular nodes
Posterior cervical nodes
Supraclavicular nodes

6.Screening test used in new borns with club foot
Inability to dorsiflex and evert the dorsum of foot so as to touch the shin
Inability to dorsiflex and invert the dorsum of foot so as to touch the shin
Inability to plantarflex and evert the sole of foot so as to touch the calf
Inability to plantarflex and invert the sole of foot so as to touch the calf

7.First step to be done is supra condylar fracture humerus with vascular injury in casualty
Angiography
Arterial Doppler
Extend elbow and remove all dressings
Operative exploration

8.Froment,s sign is positive in injury to
Ulnar nerve
Axillary nerve
Radial nerve
Median nerve

9.Austin Moore prosthesis is used in
Fracture neck of humerus
Fracture neck of scapula
Fracture neck of femur
Fracture neck of talus

10.Brodie’s abscess is most commonly seen in
Epiphysis
Metaphysic
Diaphysis
Physis

11.Blunt’s disease is
Genu valgum
Tibia vara
Flat foot
Genu recurvatum

12.Most preferable treatment in recent fractures, of femoral neck in transcervical region in a otherwise normal middle aged lady
Plaster immobilization
Osteotomy described by McMurray
Arthrodesis of hip
Osteosynthesis with cancellous screws

13.Fracure femur due to birth injury is generally found in
Upeer 1/3 of shaft
Middle 1/3 of shaft
Lower 1/3 of shaft
Neck of the femur

14.Meniscus calcification is a feature of
Gout
Hyperparathyroidism
Pseudogout
Ankylosing spondylitis

15.Housemaid’s knee is inflammation of
Subpatellar bursa
Suprapatellar bursa
Infrapatellar bursa
Prepatellar bursa

16.All of the following are ture about superior orbital fissure syndrome EXCEPT
Deep orbital pain
Frontal headache
Paralysis of 6th,3rd and 4th cranial nerves
Optic nerveinvolvement

17.Perforation of osterior suptum is commonly seen in
Syphilis
Atrophic rhinitis
Rhinolith
Lupus vulgaris

18.Laryngomalacia also called as
Congenital stidor
Laryngeal cyst
Laryngeal web
Laryngeal sacuale

19.Greisinger’s sign is seen in
Otitc hydrocephalus
Meningitis
Lateral sinus thrombosis
Extradural abscess

20.The cause of BELL’s palsy is
Acoustic neuroma
Herpes zoster infection
CSOM
Idiopathic

21.The most common quadrant for retinal break is myopia is
Lower nasal
Upper nasal
Upper temporal
Lower temporal

22.Specular microscopy is used to assess
Corneal thickness
Corneal diameter
Corneal curvature
Corneal endothelial cells

23.The most important cause of the failure in retinal surgery is
Pigmentary retinal dystrophy
Proliferative vitero-retinopathy
Ischaemic optic neuropathy
Choroidopathy

24.The refractive index of aqueous humor is
1.000
1.336
1.376
1.406

25.Commonest organism causing corneal ulcer in contact lens wearers is
Staphylococcus
Pneumococcus
Acanthoemeba
Rhinosporidiosis

26.Sodium concentration determines size of ECF compartment because
Potassium is mainly an intracellular cation
Sodium represets more thean 90% cations and osmotic pressure of ECF compartment
Sodium passes out of renal tubules actively along with passive movement of water to maintain ECF
Extracellular concentration of chloride is less than half of sodium

27.The following increase the speed of induction with an inhalational agent
Opiate pre-medication
Increased alveolar ventilation
Increased cardiac output
Reducing FiO2

28.Which of the following is naturally occurring opioid?
Penatozocine
Heroin
Fentanly
Morphine

29.The oxygen disassociation curve is shifted to the right in
Acidosis
Hypothermia
Alkalosis
Decreased 2,3-DPG

30.Which of the following is a benzodiazepine antagonist?
Oxazepam
Flumazenil
Neostigmine
Naloxone

2.The estimation of 3 methyl histidine in urine is used to study
a. Status of folate in the body
b. Renal disease
c. Skeletal muscle mass
d. Protein absorption in the

3.The preganglionic parasympathetic fibres to the parotid glad travel in
a. Lesser petrosal nerve
b. Greater petrosal nerve
c. Deep petrosal nerve
d. Internal carotid nerve

4.Which among the following is NOT an adverse effect of furosemide?
a. Hypokalemia
b. Ototoxicity
c. Hypercalcemia
d. Hyperuricemia

5.A full course of immunization against, Tetanus with 3 doses of Tetanus toxoid, confers immunity for how many years?
a. 5
b. 10
c. 15
d. 20

6.Among the secondary changes in tooth the most useful one for age determination is
a. Attrition
b. Secondary dentine deposition
c. Root resorption
d. Root transparency

7.Antigliadin antibodies are detectable in
a. Tropical spure
b. Whipple’s disease
c. Celiac disease
d. Intestinal lymphoma

8.All are causes of papilloedema EXCEPT
a. Cerebral tumours
b. Friedreich’s ataxia
c. Cavernous sinus thrombosis
d. Cerebral abscess

9.Cu T 380A IUCD should be replaced once in
a. Yrs
b. Yrs
c. Yrs
d. Yrs

10. The commonest gastric polyp is
a. Hyperplastic polyp
b. Inflammatory polyp
c. Adenomatious polyp
d. Part of familial polyposis

11. Buruli ulcer is caused by
a. Mycobacterium ulcerans
b. Mycobacterium marinum
c. Mycobacterium kansai
d. Mycobacterium fortuitum
12.Central stellate scar on CT scans are seen in
a. Renal haemangiomas
b. Renal oncocytomas
c. Wilms tumour
d. Papillomas

13.SSPE(subacute sclerosing panencephalitis) is associated with
a. Mumps
b. Chickenpox
c. Herpes
d. Measles

14.Heimlich valve is used for drainage of
a. Pneumothorax
b. Hemothorax
c. Empyema
d. Malignant pleural effusion

15.A ventilator pressure relief valve stuck in closed position can result in
a. Barotrauma
b. Hypoventilation
c. Hypoxia
d. Hyperventilation

16.The best predictor of ovulation is
a. Estrogen peak
b. Follicle stimulating hormone(FSH) surge
c. Onset of the LH surge
d. Preovulatory rise in progesterone

17.Metrifonate is effective against
a. Amoebiasis
b. Leishmaniosis
c. Schistosomiasis
d. Giardiasis

18.Thrombocytopenia due to increased platelet destruction is seen in
a. Aplastic anaemia
b. Cancer chemotherapy
c. Acute leukemia
d. Systemic lupus erythematosus

19.Case-control study is a type of
a. Descriptive epidemiological study
b. Analytical study
c. Longitudinal study
d. Experimental epidemiological study

20.Commonest complication of CSOM is
a. Sub periosteal abscess
b. Mastoididtis
c. Brain abscess
d. Meningitis

21.Periodic acid Schiff stain shows Block positivity in
a. Myeloblasts
b. Lymphoblasts
c. Monoblasts
d. Megakaryoblasts

22.The raphe uclei located in lower pons and medulla secrete the following neurotransmitter
a. Norepinephrine
b. Dopamine
c. Serotonin
d. Acetylcholine

23.Superior colliculus is concerned with
a. Olfaction
b. Hearing
c. Vision
d. Pain sensation

24.Berger nephroathy disease is due to mesangial deposition of
a. Fibrin & C3
b. IgD & C3
c. IgE & C3
d. IgA & C3

25.An emerging viral pathogen causing pyelonephritis in kidney allografts is
a. Molluscum contagiosum
b. Herpes simplex virus
c. Polyoma virus
d. Influenza virus

26.Under the National Programme for Control of blindness, the goal is to reduce the prevalence of blindness to a levelof
a. 0.1%
b. 0.3%
c. 0.5%
d. 1%

27.Wilson’s disease is characterized by
a. Low serum ceruloplasmin and low urinary copper
b. Low serum ceruloplasmin and high urinary copper
c. High serum ceruloplasmin and low urinary copper
d. High serum ceruloplasmin and high urinary copper

28.Partogram is used to
a. Assess the fetal well-being in labour
b. Assess the condition of the baby at birth
c. Record the eventrs 0f pregnancy
d. Assess the progress of labour

29.The Reynold’s pentad of fever, jaundice, right upper quadrant pain, septic shock and mental status change is typical of
a. Cholangitis
b. Hepatitis
c. Cholecystitis
d. Pancreatitis

30.The drug that has the fastest onset of action in benign prostatic hyperplasia is
a. Finesteride
b. Tamsulosin
c. Dutasteride
d. Flutamide

31.Nipple shadows on chest radiographs characteristically have a sharp
a. Lateral margin
b. Medial margin
c. Inferior margin
d. Superior margin

32.Acute and recurrent pancreatitis is reported to occur in
a. Homocystinuria
b. Maple syrup urine disorder
c. Methyl melonic academia
d. Tyrosinemia

33.Long term use of lithium is associated with the following endocrine abnormality
a. Hypothyroidism
b. Diabetes mellitus
c. Hyperthyroidism
d. Cushing’s syndrome

34.Spina Ventosa is caused by
a. Tuberculosis
b. Leprosy
c. Brucellosis
d. Sickle cell disease

35.The drug used in the treatment of idiopathic hypercalciuria is
a. Allopurinol
b. Frusemide
c. Acetazolamide
d. Thiazide

36.Copper sulphate poisoning manifests with
Acute hemolysis
High anion gap acidosis
Peripheral neuropathy
Rhadbdomyolysis

37.A 28 year old male complains of glare in both eyes. The cornea shows whorl like opacities of the epithelium. He also giave a history of long term treatment with amiodarone. The most likely diagnosis is
a. Terrrain,s marginal degeneration
b. Corneal verticillata
c. Band shaped keratopathy
d. Arcus juvenalis

38.The tumor causing polycythemia due to erythropoietin production is
a. Cerebellar hemangioma
b. Medulloblastoma
c. Ependymoma
d. Oligodendroglioma

39.In the mucosal cells, triglycerides are formed primarily in the
a. Rough endoplasmic reticulum
b. Smooth endoplasmic reticulum
c. Golgi apparatud
d. Ribosomes

40.The last tributary of the azygos vein is
a. Right superior intercostals vein
b. Hemi-azygos ven
c. Right bronchial vein
d. Accessory azygos vein

41. In the stomach, H+ ions are secreted in exchange for
a. Na+
b. K+
c. Ca+
d. Cl-

42. The causative agent of Favus is
a. Microsporum audounii
b. Microsporum canis
c. Trichophyton mentagrophyte
d. Trichophyton schoenleinii

43.Mycetoma is caused by the following agents EXCEPT
a. Allescheria boydii
b. Madurella mycetomii
c. Trichosporum beigelli
d. Nocardia steroids

44.The poison that can be detected after death in hair is
a. Lead
b. Copper
c. Mercury
d. Arsenic

45.The following are grades of binocular single vision, EXCEPT
a. Simultaneous macular perception
b. Fusion
c. Stereopsis
d. Suppression

46.The ECG change seen in hyis
a. Narrowing of the QRS complex
b. Increased amplitude of P waves
c. Narrowing and peaking of T waves
d. Prominent U waves

47.Association of sexual precocity, multiple cystic bone lesions and endocrinopathies are seen in
a. McCune-Albright’s syndrome
b. Granulosa cell tumor
c. Androblastoma
d. Hepatoblastoma

48.Amaurosis fugax refers to occlusion of
a. Middle cerebral artery
b. Retinal artery
c. Renal vessels
d. Mesentric vessels

49.Early and reliable indication of air embolism during anaesthesia can be obtained by continuous monitoring of
a. ECG
b. Blood Pressure
c. End tidal CO2
d. Oxygen saturation

50.The following is a life threatening side effect associated with the use of clozapine
a. Pancreatitis
b. Hypoglycemia
c. Agranulocytosis
d. Acute renal failure

51.Which of the following antitumor agents works by impairing de novo purine synthesis?
a. Hydroxyurea
b. 5-fluorouracil
c. Methotrexate
d. Allopurinol

52.The dangerous particle size causing pneumoconiosis varies from
a. 100-150 um
b. 50-100 um
c. 10-50 um
d. 1-5 um

53.Swinging flash light test is used to examine
a. Cornea
b. Pupil
c. Lens
d. Conjunctiva

54.The recommended content of Iodine in salt at the consumer level is
a. 10 ppm
b. 15 ppm
c. 20 ppm
d. 30 ppm

55.Which of the following DOES NOT cause an increase in serum amylase?
a. Pancreatitis
b. Carcinoma lung
c. Renal failure
d. Cardiac failure

56.Refeeding edema is due to increased release of
a. Growth hormone
b. Glucocorticoids
c. Insulin
d. Thyroxine

57.Fetal erythropoeisis first occurs at what week of gestation?
a. 6
b. 10
c. 12
d. 14

58.The most common site of ectopic phaeochromocytoma is
a. Organ of zukerkandl
b. Bladder
c. Filum terminale
d. Celiac plexus

59.Pitting of nails can be seen in
Tinea unguium
Alopecia areata
Androgenetic alopecia
Peripheral vascular disease

60.Which of the follwing conditions is predominant in females?
Talipes equinovarus
Cleft palate
Congenital hip dislocation
Pyloric stenosis

61.Antipsychotic induced ‘akathisia, is characterized by
a. Rigidity
b. Tremor
c. Spasm of muscle/muscle group
d. Restlessness

62.Which one of the following causes of hypoxemia is NOT corrected by giving supplemental oxygen?
a. Ventilation perfusion mismatch
b. Alveolar hypoventilation
c. Impairment of diffusion
d. Right to left shunt

63. Moth eaten alopecial is seen in
a. Black dot tinea
b. Telogen effluvium
c. Alopecia areata
d. Secondary syphilis

64.The most common benign tumor of the lung is
a. Hamartoma
b. Alveolar adenoma
c. Teratoma
d. Fibroma

65.Grey Turner,s sign (flank discoloration) is seen in
a. Acute pyelonephritis
b. Acute cholecystitis
c. Acute pancreatitis
d. Acute peritonitis

66.Yellow fever is absent in india because
a. Climatic conditions are not favourable
b. Virus is not present
c. Vector mospuito is absent
d. Population is immune

67. The objective of National Population Policy 2000 is to bring Total Fertility Rate to replacement levels by the year
a. 2005
b. 2010
c. 2015
d. 2020

68.Mucin clot test is done to detect
a. Mucin in stool
b. Proten in CSF
c. Hyaluronate in Synovial fluid
d. Protein in pleural fluid

69.Facial angle is a rough index of the degree of development of the
a. Jaws
b. Nose
c. Brain
d. Eyes

70.The epithelial lining of the urethra below the opening of the ejaculatory ducts is
a. Stratified cuboidal epithelium
b. Stratified columnar epithelium
c. Transitional epithelium
d. Stratified squamous epitherlim

71.Vascular involvement and thrombosis is seen in
a. Coccidioidomycosis
b. Aspergillosis
c. Mucormycosis
d. Histoplasmosis

72.Pawn ball megakaryocyetes are characteristic of
a. Myelodysplastic syndrome
b. Idiopathic thrombocytopenic purpura
c. Thrombotic thrombocytopenic purpura
d. Chloramphenicl toxicity

73.Argon Laser trabeculoplasty is done in
a. Open angle glaucoma
b. Secondaryglaucoma
c. Angle recession glaucoma
d. Angle closure glaucoma

74.The systolic ejection murmur in hypertrophic obstructive cardiomyopathy is diminished when a patient
a. Performs the valsalva maneuver
b. Lies down
c. Inhales amy nitrite
d. Stands up

75. Multiple sites of narrowing of peripheral pulmonary artery occurs with
a. Roseola
b. Rubeola
c. Rubella
d. Rocio virus disease

76.Which of the following drugs is most likely to cause myocardial depression?
a. Morphine
b. Thiopental
c. Etomidate
d. Ketamine

77.Congenital long QT syndrome is associated with neonatal
a. Sinus bradycardia
b. Sinus tachycardia
c. Supra ventricular tachycardia
d. Ventricular tachycardia

78.The interstitial lung disease(ILD) showing granulomas on lung biopsy is
a. Usual interstitial pneumonitis
b. Sarcoidosis
c. Diffuse alveolar damage
d. Desquamative interstitial pneumonia

79.Normal portal vein pressure is
a. < 3 mm Hg
b. <3-5 mm Hg
c. <5-10 mm Hg
d. <10 to 12 mm Hg

80.The single most useful clinical sign of severity of pneumonia in a person without underlying lung disease is
a. Temp more than 38.5 C
b. Heart rate more than 100/min
c. Systolic BP less than 90 mm Gh
d. Respiratory rate less than 30/min

81.Sclera is thinnest at
a. Limbus
b. Insertion of recti
c. Posterior pole
d. Equatorun

82. Onion skin thickening of arteriolar wall is seen in
a. Atherosclerosis
b. Median calcific sclerosis
c. Hyaline arteriolosclerosis
d. Hyperplastic arteriolosclerosis

83.The principal polypeptide that increase food intake are the following EXCEPT
a. Neuropeptides – Y
b. Leptin
c. Orexin – A
d. B – endphrin

84.Proximal convoluted tubule have which type of aquaporins?
a. Aquaporin 1
b. Aquaporin 2
c. Aquaporin 5
d. Aquaporin 9

85.The cofactor required for the activity of Sulfite oxidase is
a. Copper
b. Selenium
c. Molybdenumun
d. Zinc

86.cAMP action mediates all EXCEPT
a. Glucagon
b. Follicle stimulating hormone
c. Leutinizing hormone
d. Estrogen

The first line of treatment of open angle glaucoma is
a. Timolol
b. Pilocarpine
c. Epinephrine
d. Carbonic anhydrase inhibitor

88.The following bacteria can invade intact corneal epithelium EXCEPT
a. Nisseria gonorrhoew
b. Haemophilus influenzae
c. Staphylococcus aureus
d. Listeria species

89.Duffy blood group antigen negativity confers protection against infection by
a. Plasmodium falciparum
b. Plasmodium ovale
c. Plasmodium vivax
d. Plasmodium malariae

90.In a 6 year old child with burns involving the whole of head and trunk, the estimated body surface area of burns is
a. 44%
b. 52%
c. 55%
d. 58%

91.Most common medial meniscal tear is
a. Longitudinal tear
b. Oblique tear
c. Radical tear
d. Horizontal tear

92.Pendred’s syndrome is due to a defect in
a. Chromosome 7p
b. Chromosome 7Q
c. Chromosome 8p
d. Chromosome 8q

93.Fecal leucocytes are absent in all the following EXCEPT
a. Giardiasis
b. Cryptosporidiasis
c. Campylobacter infection
d. Clostridium perfringes infection

94.The recommended drug for the prophylaxis of influenza A and B is
a. Acyclovir
b. Ganciclovir
c. Amantadine
d. Foscarnet

95.Spontaneous absorption of lenticular material is seen in
a. Myotoinc dystrophy
b. Hallermann Streiff Syndrome
c. Aniridia
d. Persistend hyperplastic primary vitreous

96An increase in protein without pleocytosis in cerebrospinal fulid is seen in
a. Froin’s syndrome
b. Guillain Barre syndrome
c. Pyogenic meningitis
d. Tuberculous meningitis

97.In case of drug that follows first order elimination
a. The rate of elimination is constant
b. The elimination half life varies with dose
c. The clearance varies with dose
d. The rate of elimination varies directly with dose

98.A major lipid of mitochondrial membrane is
a. Lecithin
b. Inositol
c. Plasmalogen
d. Cardiolipin

99.Which of the following tendons is lengthened in posteromedial soft tissue release for idiopathic congenital talipes equinovarus
a. Tibalis anterior
b. Tibialis posterior
c. Extensor digitorum longus
d. Flexor hallucis longus

100.All the following are used in first trimester MTP EXCEPT
a. Dilatation and evacuation
b. Ru 486
c. Suction and evacuation
d. Ethacrydine extra amniotic

101.Gustatory hallucinations are most commonly associated with
a. Temporal lobe epilepsy
b. Grand mal epilepsy
c. Anxiety disorders
d. Tobacco dependence

102.The limit of loudness expressed as decibels that people can tolerate without substantial damage to their hearing is
a. 55
b. 65
c. 75
d. 85

103.The species origin of blood can be detected by
a. Benzidine test
b. Takayama test
c. Spectroscopy
d. Precipitin test

104.Sling psychrometer is used for measuring
a. Air velocity
b. Rainfall
c. Median radian temperature
d. Relative humidity

105. Fetishism is a sexual perversion characterized by
a. Sexal focus on children
b. Sexual focus on genital rubbing
c. Sexual pleasure from pain
d. Sexual pleasure derived from now living objects

106.Emporiatrics deals with the health of the
a. Farmers
b. Travelers
c. Industrial workers
d. Mine workers

107.Agoraphobia is a disorder characterized by all of the following EXCEPT
a. Visual hallucinations
b. Avoidance of situations in which it is difficult to obtain help
c. Presence of panic symptoms
d. Avoidance of being outside alone

108.Obective assessment of the refractive state of the eye is termed
a. Retinoscopy
b. Gonioscopy
c. Opthalmoscopy
d. Keartoscopy

109.The single most important sign in suspecting early Volkmann’s contracture is
a. Pallor of the fingers
b. Pain
c. Obliteration of the pulse
d. Paralysis of the involved muscles

110.Gartner’s duct is remnant of
a. Mullerain duct
b. Wollfian duct
c. Cloacal duct
d. Epoopharon

111.Which immunoglobulin crosses placenta?
a. IgM
b. IfA
c. IgG
d. IgD

112.All of the following are tumor necrosis factor blocking agents EXCEPT
a. Adalimumab
b. Etanercept
c. Infliximab
d. Adciximab

113.Which vrus given below is not a teratogenic virus?
a. Rubella
b. Cytomegalovirus
c. Herpes simplex
d. Measles

114.Postmortem rigidity first starts in
a. Eyelids
b. Neck
c. Upper limbs
d. Lower limbs

115.The anopheles species most commony found in coastal regions is
a. Anopheles philippinensis
b. Anopheles stephensi
c. Anopheles fluviatilis
d. Anopheles minimus

116.Increased frequency of HLA-B is seen in all the following diseases EXCEPT
a. Ankylosing spondylitis
b. Reiters syndrome
c. Acute anterior uveitis
d. Myasthenia gravis

117.Ghrelin is responsible for
a. Stimulaton of appetite
b. Suppression of appetite
c. Stimulation of sleep
d. Suppression of sleep

118.Prepyloric or channel ulcer in the stomach is termed as
a. Type 1
b. Type 2
c. Type 3
d. Type 4

119.Kelphic nodes are
a. Pretracheal
b. Paratracheal
c. Supraclavicular
d. Posterior triangle

120.Selenium sulfide is indicated for treating
a. Tinea versicolor
b. Tinear corporis
c. Mixed mycotic infections
d. Candidiasis only

121.Which of the mmunoblobulins is associated with allergic disorders?
a. IgG
b. IgM
c. IgA
d. IgE

122.The following are associated with Fibular Hemimelia EXCEPT
a. Short tibia
b. Anterior bowing of the leg
c. Equino-valgus deformity of the foot and ankle
d. Presence of polydactyly

123.In an asthmatic patient which of the following pulmonary functions would show the greater improvement on inhaling a bronchodilator?
a. Tidal volume
b. FEV1
c. FEF 25$-75%
d. FVC

124.Bone infarcts are ssen in
a. Iron deficiency anaemia
b. Thalassemia
c. Sickle cell anaemia
d. Hereditary spherocytosis

125.The most common organism isolated in Emphysematous pyelonephritis is
a. E. Coli
b. Proteus
c. Pseudomonas
d. Klebsiella

126.Bilateral Renal cell carcinoma is seen in
a. Eagle Barett’s syndrome
b. Beckwith Weidemman syndrome
c. Von Hippel Lindau disease
d. Bilateral Angiomyolipoma

127.”Maldon teeth” is due to
a. Lead
b. Fluoride
c. Calcium
d. Phosphorus

128.The most commonform of diabetic neuropathy is
a. Acutemononeuropathy
b. Autonomic neuropathy
c. Polyradiculopathy
d. Distal symmetric polyneuropathy

129.Bhopal gas tragedy is an example of
a. Point source epidemic
b. Continuous epidemic
c. Propagated epidemic
d. Slow epidemic

130.Sex can be established by examining hair root cells for the presence of
a. Davidson body
b. Barr body
c. Golgi body
d. Medullar indes

131.Which one given below is a DNA virus?
a. Polio virus
b. Adenovirus
c. Parvovirus
d. Hepatitis-A virus

132.Which of the following drugs can help the ducturs arteriosus patent prior to surgery for pulmonary stenosis in a neonate?
a. Alprostadil
b. Indomethacin
c. Carboprost
d. Misoprostol

133.Which of the following types of nerve fibres carry pain?
a. A alfa
b. A beta
c. A gamma
d. A delta

134.Alpha fetoprotein is genetically and structurally related to
a. Albumin
b. Transferrin
c. Fibrinogen
d. Growth hormone

135.Which muscle is a abductor of the vocal cords?
a. Transverse arytenoids
b. Oblique arytenoids
c. Lateral thyroarytenoid
d. Posterior cricoarytenoid

136.The supraoptic nucleus of the hypothalamus is believed to control secretion of which of the following hormones?
a. Antidiuretic hormone
b. Oxytocin
c. Growth hormone
d. Adrenocorticotrophic hormone

137.Which among the following drugs is safest in a patient allergic to penicillin
a. Cephalexin
b. Imipenem
c. Cefepime
d. Aztreonam

138.Microalbuminuria is defined as protein levels of
a. 100-150mb/L
b. 151-200mg/L
c. 201-300mg/L
d. 301-600mg/L

139.Recruitment phenomenon is seen in
a. Otosclerosis
b. Meniere’s disease
c. Acoustic nerve schwannoma
d. Otitis media with effusion

140.Among the pulses, the highest quantity of proten is present in
a. Green gram
b. Red gram
c. Soyabean
d. Black gram

141.Which one of the following is direct thrombin inhibitor?
a. Enoxiparin
b. Daltiparin
c. Fondaparnux
d. Argatroban

142.Hemiparesis is NOT a feature of
a. Carotid artery occlusion
b. MCA occlusion
c. ACA occlusion
d. Vertebral artery occlusion

143.The most common tumor of the minor salivary gland is
a. Mucoepidermoid carcinoma
b. Acinic cell carcinoma
c. Adenoid cystic carcinoma
d. Pleomorphic adeno carcinoma

144.Which of the following local anaesthetics is also an antiarrythmic
a. Procaine
b. Lignocaine
c. Bupivacaine
d. Cocaine

145.At the end of 1 yr of age, the number of carpal bones seen in the skiagram of the hand is
a. Nil
b. 1
c. 2
d. 3

146.All the following are the radiological features of osteomalacia EXCEPT
a. Triradiate pelvis
b. Milkman’s fractures
c. Osteopenia
d. Lytic lesions

147.Kienbock disease is due to avascular necrosis of the
a. Talus
b. Lunate
c. Pisiform
d. Medial tibial condyle

148.Which of the following inhalation anaesthetics should be avoided in middle ear surgery wen tympanic grafts are used?
a. Halothane
b. Nitrous oxide
c. Ether
d. Isoflurane

149.Von Brun’s nest is seen in
a. Normal urothelium
b. Transitional cell carcinoma
c. Squamous cell carcinoma
d. Adeno carcinoma

150.Unilateral steppage gait occurs in all EXCEPT
a. L5 radiculopathy
b. Sciatic neuropathy
c. Peroneal neuropathy
d. Distal polyneuropathy

151.Time required for development of parasite from the gametocyte to sporozite stage in mosquito is called as
a. Extrinsic incubation period
b. Intrinsic incubation period
c. Generation time
d. Median incubation period

152.Trotter,s triad is seen in carcinoma of
a. Maxilla
b. Larynx
c. Nasopharynx
d. Ethoidal sinus

153.In myocardial infarction, microscopic picture of coagulation necrosis with neutrophilic infiltration is seen in
a. 4-12 hrs
b. 12-24 hrs
c. 1-3 days
d. 3-7 days

154.The drug of choice in paroxysmal supraventricular tachycardia is
a. Digoxin
b. Adenosine
c. Nifedipine
d. Esmolol

155.Which of the following amino acids is purely ketogenic?
a. Phenyalanine
b. Leucine
c. Praline
d. Tyrosine

156.Which of the following laryngeal muscles is supplied by the external laryngeal nerve?
a. Posterior cricoarytenoid
b. Lateral cricoarytenoid
c. Cricothyroid
d. Thyroarytenoid

157.The biosynthesis of the enzyme pyruvate carboxylase is repressed by
a. Insulin
b. Gucagon
c. Cortisol
d. Epinephrine

158.Which among the following general anaesthetic causes cardiovascular stimulation?
a. Thiopental
b. Ketamine
c. Midazolam
d. Etomidate

159.The antibody produced during primary immune response is
a. IgM
b. IgG
c. IgA
d. IgE

160.Pneumonia alba is due to
a. Klebsiella
b. Streptococci
c. Treponema pallidum
d. Staphylococci

161.The maximum hours of work per week prescribed under the Factories Act is
a. 42
b. 48
c. 54
d. 60

162.Mineral oils are used in mosquito control measure as
a. A personal protection method
b. Larvicide
c. Adulticide
d. Space spray

163.Digoxin can accumulate to toxic levels in patients with
a. Renal insufficiency
b. Chronic hepatitis
c. Advance cirrhosis
d. Chronic pancreatitis

164.The screening test for gestational diabetes mellitus that has the highest sensitivity is
a. Glycosylated Hb
b. Blood fructosamine
c. 50 gram glucose challenge test
d. Random blood sugar

165.Dose of Anti-D gamma globulin following first trimester abortion is
a. 50 mug
b. 100 mug
c. 200mug
d. 300 mug

166.The commonest clinical pattern of basal cell carcinoma is
a. Nodular
b. Morpeaform
c. Superficial
d. Keratotic

167.Which of the following does NOT increase neuromuscular blockade
a. Clindamycin
b. Lincomycin
c. Streptomycin
d. Erythromycin

168.’Bird of prey’ sign is seen in the radiographic barium examination of
a. Gastric volvulurs
b. Intussusception
c. Sigmoid colon
d. Caecal volvulus

169.All are true of cerebral salt wasting EXCEPT
a. Increased urine output
b. Low intravascular volume
c. Low uric acid in serum
d. Decreased vasopressin levels

170.Which of the following tools can be used for self monitoring of asthma?
a. Spirometer
b. Peak flow meter
c. Plethysmograph
d. Ventilator

171. Commonest cause of heart failure in infancy is
a. Myocarditis
b. Rheumatic fever
c. Cardiomyopathy
d. Congenital heart disease

172.Perioral pallor and Dennie’s line are seen in
a. Atopic dermatitis
b. Chronic actinic dermatitis
c. Blood dyscrasias
d. Peroral contact dermatitis

173.Which one of the following is used as an irrigation solution during transurethral resection of the prostate?
a. 1.5% glycine
b. Physiological saline
c. Ringer’s lactate
d. 5% dextrose

174.Commonest tumor of the cervix is
a. Sqamous cell carcinoma
b. Adenocarcinoma
c. Sarcoma
d. Adenoacanthoma

175.The tumour marker for endodermal sinus tumour is
a. HCG
b. Human p;acental lactogen
c. CA 125
d. Alpha fetoprotein

176.The earliest clinical sign of Vitamin A deficiency is
a. Conjunctival xerosis
b. Corneal xerosis
c. Bitots spots
d. Keratomalacia

177.Which of the following tests is most sensitive for detecting early diabetic nephropathy?
a. Serum creatinine
b. Creatinine clearance
c. Microalbuminuria
d. Ultrasongography

178.In normal condition of temperature and atmosphere, the rate of colling of dead body is
a. degree F/hour
b. 1.5 degree F/hour
c. degree F/hour
d. 2.5 degree F/hour

179.Oral contraceptive pill of choice in a lactating woman is
a. Monophasic pill
b. Biphasic pill
c. Triphasic pill
d. Mini pill

180.Linear striations are typically seen in
a. Vertebral myeloma
b. Vertebral lymphangiomas
c. Vertebral metastases
d. Vertebral haemangiomas

Rajiv Gandhi University of Health Sciences, Karnataka, Bangalore is conducting Counselling for selection of seats for admission to M.D, M.S., and Diploma courses in Medical subjects and MDS courses in Dental subjects in Government Medical and Dental colleges and government seats in Private and Minority Medical and Dental colleges located in the state of Karnataka for 2008-09 academic year.

The schedule of first round of Counselling is given in Appendix below

1. Eligibility
All the candidates who have qualified in the PG Entrance Test held on 3rd February 2008 are eligible to attend the Counselling as per the merit list announced on 23rd February 2008.

The candidates should attend the Counselling in person for selection of seats.

2. Venue : Dhanavantari Hall, Rajiv Gandhi University of Health Sciences,
4th T Block, Jayanagar, Bangalore – 560041

3. Certificates to be submitted:
The candidates should submit the following original certificates at the time of Counselling for verification.

1.
PGET Original Admission Ticket
2.
SSLC or equivalent certificate for proof of date of birth
3.
MBBS / BDS Marks Cards of all years
4.
Internship Completion Certificate from the Principal
5.
Degree Certificate
6.
Council Registration Certificate
7.
Caste & Income Certificate issued by the Tahasildhar
8.
School Leaving Certificate/TC or Cumulative Record
(The candidates who have claimed reservations)
9.
Domicile Certificate, if applicable
10.
Passport size recent photos – 2 Nos.

The candidates should make use of the Acknowledgement Form given in Appendix II to tick (Ö) the certificates enclosed and to arrange the certificates in that order. The acknowledgement form along with the original certificates should be submitted to university officials for verification at the time of registration for Counselling.

If the original certificates are not produced the candidate shall forfeit the
claim for allotment of seat.

However, the candidates who could not submit their original certificates having deposited them at All India Entrance Test / COMED-K / any other institutions conducting the entrance test, have to produce an endorsement / acknowledgement issued by the Principal of the admitted college and should also submit the Demand Draft of Rs.10,000/- for Degree and Rs.5,000/- for Diploma in the name of Registrar, RGUHS, Bangalore, before getting the allotment order from RGUHS. The amount will be refunded in the month of June 2008 only, if the candidate joins the course and produces the original certificates before 31st May 2008. The amount will not be refunded if the candidate takes the allotment letter and fails to join the course within the due date.

4. Fee Structure

The Fee Structure of 2008-09 will be announced in the website as soon as the receipt of it from the Government. For the benefit of students the Fee Structure of last year has been given

The fee structure for various courses in Government, Private and Minority Medical and Dental colleges notified by Government of Karnataka in G.O. No.HFW 407 MPS 2006 dated 8th March 2007 is as given below:

Fee Structure for Post Graduate Students selected under 33% Government Quota seats in Private Colleges during 2007-08
Course
Total Fee (100%)
Fee after reduction of 33%
1. Medical

a) Degree

- Clinical
Rs. 4,56,000/-
Rs. 3,05,000/-
- Para Clinical
Rs. 1,14,000/-
Rs. 76,000/-
- Pre Clinical
Rs. 57,000/-
Rs. 38,190/-
b) Diploma

- Clinical
Rs. 3,42,000/-
Rs. 2,29,000/-
- Para Clinical
Rs. 1,14,000/-
Rs. 76,000/-
2. Dental Degree

- Clinical
Rs. 2,34,000/-
Rs. 1,56,000/-
- Para Clinical
Rs. 78,000/-
Rs. 52,260/-

Fee Structure for Post Graduate Students selected under 20% Government Quota seats in Karnataka Linguistic Minorities Professional Colleges during 2007-08
Course
Total Fee (100%)
Fee after reduction of 20%
1. Medical

a) Degree

- Clinical
Rs. 3,45,000/-
Rs. 2,76,000/-
- Para Clinical
Rs. 95,000/-
Rs. 76,000/-
- Pre Clinical
Rs. 47,000/-
Rs. 37,600/-
b) Diploma

- Clinical
Rs. 2,76,000/-
Rs. 2,20,800/-
2. Dental Degree

- Clinical
Rs. 1,92,500/-
Rs. 1,54,000/-
- Para Clinical
Rs. 68,000/-
Rs. 54,400/-

Fee Structure for Post Graduate Students in Government Colleges:

Course
Total Fee
1. Medical

a) Degree

- Clinical
Rs. 20,000/-
- Para Clinical
Rs. 10,000/-
- Pre Clinical
Rs. 5,000/-
b) Diploma

- Clinical
Rs. 20,000/-
- Para Clinical
Rs. 10,000/-
2. Dental Degree

- Clinical
Rs. 20,000/-
- Para Clinical
Rs. 5,000/-

The candidates who have selected seats should pay the prescribed fee at the time of counseling in the form Demand Draft taken in favour of Registrar, RGUHS, Bangalore.

5. Seat Matrix :

The seat matrix of 2008-09 will be announced in the website as soon as the receipt of it from the Government. For the benefit of students the Seat Matrix of 2007-08 has been given

Sl.
No.

Details of quota
Medical

Dental
Degree
Diploma
1.
In-service
89
64
43
2.
Entrance
178
126
99
3.
Physically Handicapped
3
3
-
Total
270
193
142

6. Procedure of conduct of Counselling :

The entire Counselling process has been computerized right from the registration of candidates to issue of allotment letter.

· Registration
The candidates should register their names at the entrance of the Counselling hall by producing the PGET 2008 Hall Ticket and move to the allotted verification counter for submission of original certificates.

· Verification of original certificates
The candidates should produce Acknowledgement Form along with all the original certificates for verification by university officials. The original certificates will be kept in the university till the approval of admission by RGUHS. Therefore, the candidates are advised to keep sufficient Xerox copies of their certificates before submitting them to the university.

· Selection of Seats
After submission of original certificates, the candidates will be allowed for selection of seats in the order of their merit only.

· Issue of Allotment Letters
The candidates who have selected seats should produce two recent passport size photos and get the allotment letters by affixing their signature in the register. The candidates should get admitted in the allotted college on or before the due date mentioned in the allotment letter, failing which the seat will be automatically stands cancelled.

7. Criteria for selection of seats for Government of Karnataka In-service Candidates

· No in-service candidate shall be eligible for admission to Post Graduate Degree and Diploma courses in any subject other than the Speciality in which he is working.
· An in-service candidate who is already holding a Post Graduate Degree in any speciality shall not be eligible for admission to any other Post Graduate Degree or Diploma.
· An in-service candidate who is already holding a Post Graduate Diploma in any speciality, through Government deputation, shall be eligible for admission to Post Graduate Degree courses in the same speciality and shall not be eligible for any other Post-Graduate Degree or Diploma courses.
· An in-service candidate who is already studying in any Post-Graduate Degree or Diploma course shall not be eligible for admission under these rules.

8. Forfeiture of seats selected during Counselling :

· Every candidate including in-service candidate shall pay a sum of Rs. 10,000/- for Degree and Rs. 5,000/- for Diploma to the Government in case he/she takes allotment orders during Counselling and fails to join the course.

· Every candidate except in-service candidate at the time of admission shall furnish a bond on a stamped paper of Rs.100/- binding himself to pay a sum Rs.50,000/- in case of Degree and Rs.25,000/- in case of diploma along with the stipendary amount received by him/her in the event of leaving the course before its completion.

· All the selected in-service candidates at the time of admission shall furnish a bond in the form specified by the committee on stamp paper of value of Rs.100/- binding himself to pay a sum of Rs.50,000/- for Degree and Rs.25,000/- for Diploma courses as penalty in the event of his/her leaving the course before its completion and also debarred for three years from appearing entrance test. All the selected in-service candidates at the time of admission shall furnish a bond to the effect that they will be rendering service in the Government for a minimum period of Ten years or till the attainment of superannuation, whichever is earlier.

· Every candidate shall pay the remaining period course fee to the Government/ Private colleges in the event he/she leaving the course before its completion. In case of an in-service candidate, the amount equal to the fee for remaining period of course shall be recovered from the salary of such in-service candidate.

· Candidates selecting Government Colleges & Government seats in Private colleges (under concession fee) for Post Graduate courses shall furnish an undertaking that he/she will serve the Government for a minimum period of 3 years after completion of the course, if Government desires.

· Candidates who avail 100% tuition fee reimbursement from the Government shall furnish an undertaking that he/she will serve the Government for a minimum period of 5 years, if Government desires.

· A penalty of Rs.5,00,000/- for degree and Rs.3,00,000/- for diploma shall be levied incase the candidates fail to serve the Government after completion of the course as per the undertaking

9. Admission of Selected candidates

The selected candidates shall get themselves admitted to the colleges allotted by furnishing relevant undertakings mentioned above within the due date notified by the selection committee, failing which their selection shall stand automatically cancelled. However, the admission shall be provisional and subject to the approval of the concerned universities.

10. All the eligible candidates can attend subsequent rounds of counselling irrespective of whether they have selected the seat in the first round or not. Further, the candidates who could not attend first round of counselling can also attend the subsequent rounds of counselling.

NOTE: The candidates are advised to strictly adhere to the above said rules. Lenience in any matter explained above will not be entertained. The Postgraduate Selection Committee holds all the powers to cancel the candidature of candidates who do not comply with the rules and regulations.

Appendix

Schedule of First Round of Counselling

DENTAL

Session I
9.30 AM to 11.30 AM
Reporting Time 9.00 AM
Session II
11.30 AM to 1.30 PM
Reporting Time 11.00 AM
Session III
2.00 PM to 4.00 PM
Reporting Time: 1.30 PM

Session IV
4.00 PM to 6.00 PM
Reporting Time: 3.30 PM
Rank Numbers
01.04.2008
Tuesday

1 to 100
101 to 250
251 to 450
451 to 700
02.04.2008
Wednesday

701 to 1000
1001 to 2106
–
–
MEDICAL

Session I
9.30 AM to 11.30 AM
Reporting Time 9.00 AM
Session II
11.30 AM to 1.30 PM
Reporting Time 11.00 AM
Session III
2.00 PM to 4.00 PM
Reporting Time: 1.30 PM
Session IV
4.00 PM to 6.00 PM
Reporting Time: 3.30 PM
Rank Numbers
02.04.2008
Wednesday

–
–
*
Physically Handicapped quota – all candidates
& Entrance Quota -
1 to 100
101 to 250
03.04.2008
Thursday

251 to 400
401 to 700
701 to 1100
1101 to 1600
04.04.2008
Friday

1601 – 2000
2001 – 2500
2501 – 3250
3251 – 6188
05.04.2008
Saturday

Medical – In-service quota of Autonomous Institutions, B&C, ME and ESI
Dental In-service quota – All ranks
Medical – In-service quota of Health & Family Welfare department

*
The Physically Disabled candidates should appear before the Medical board on 31.03.2008 at RGUHS Bangalore at 11.00 AM for Medical Examination. The candidate who fails to appear before the committee on 31.03.2008 for medical examination will not be eligible for selection of a seat under Physically Disabled quota.

Please Note: Counselling closes after the allotment of last seat in the seat matrix

Source: http://www.rguhs.ac.in/

Merkel cell carcinoma is a rare but extremely aggressive cancer that tends to spread rapidly. The incidence of this skin cancer has reportedly tripled over the past 20 years, to about 1500 cases a year. It tends to be seen in the elderly and in those with compromised immune systems, such as those with AIDS or patients taking transplant-related immunosuppressant drugs. About half of those with advanced Merkel cell carcinoma live 9 months or less.

“If these findings are confirmed, we can look at how this new virus contributes to a very bad cancer with high mortality and, just as important, use it as a model to understand how cancers occur and the cell pathways that are targeted,” senior author Patrick Moore, MD, from the University of Pittsburgh School of Medicine, in Pennsylvania, said in a news release. “Information that we gain could possibly lead to a blood test or vaccine that improves disease management and aids in prevention.”

Dr. Moore and his wife also discovered the cause of Kaposi’s sarcoma. In 1993, the couple identified Kaposi’s sarcoma–associated herpesvirus, the most common malignancy in AIDS patients and the most prevalent cancer in Africa.

During an interview with Medscape Oncology, Dr. Moore said his team was surprised by this latest finding. “We were certainly taken aback,” he said. “I think anyone uncovering what could be a cause of cancer would be surprised by the finding,” he laughed. A lot of work remains, but the Merkel cell polyomavirus might be an exciting clue.

Possible Cause of Rare Cancer Identified

Vaccines are now available against other causes of cancer, such as the human papillomavirus linked to cervical cancer. “The Merkel cell polyomavirus is another model that may increase our understanding of how cancers arise, with possibly important implications for nonviral cancers like prostate or breast cancer,” coauthor Yuan Chang, MD, also from the University of Pittsburgh, pointed out in a news release.

Merkel cell polyomavirus, like the human papillomavirus, is said to integrate into the tumor cell genome, but not the genome of healthy cells. This integration destroys the virus’s ability to replicate normally and might be the first step toward cancer.

Using a technique called digital transcriptome subtraction, the investigators looked at close to 400,000 messenger ribonucleic acid genetic sequences from 4 samples of Merkel cell carcinoma tumor tissue. They compared the sequences expressed by the tumor genome to gene sequences mapped by the Human Genome Project and systematically subtracted known human sequences to identify a group of genetic transcripts that might be from a foreign organism.

They found that 1 sequence was similar to, but distinct from, all known viruses. The team went on to show that this sequence belonged to a new polyomavirus present in 8 of 10 Merkel cell tumors they tested, but only 5 of 59 (8%) control tissues from various body sites and 4 of 25 (16%) control skin tissues.

“This is a rare cancer so it’s hard to get enough tissue samples for large studies from just 1 center,” Dr. Moore told Medscape Oncology. The group plans to continue collecting samples and will partner with others.

Even if the Merkel cell polyomavirus is proven to play a role in neuroendocrine cancer of the skin, Dr. Chang cautions that the virus is likely to be just part of a much larger picture.

“Now we need to find out how it works,” she explained in a news release. “Once the virus integrates, it could express an oncoprotein, or it could knock out a gene that suppresses tumor growth. Either way, the results are bound to be interesting.”

The researchers have disclosed no relevant financial relationships.

“Our analyses provide robust population-based estimated survival for incident dementia by age, sex, and setting,” the researchers, with senior author Carole Brayne, MD, from the Institute of Public Health, University of Cambridge, United Kingdom, conclude. While some of these findings may seem “self-evident,” the authors write, “they answer questions asked by those caring for and advising people with dementia. We hope the estimates will be valuable to patients, clinicians, carers, service providers, and policy makers.”

The findings, from the Medical Research Council Cognitive Function and Ageing Study (MRC CFAS), were published January 10 in the BMJ.

Doubling Dementia

Life expectancy is increasing globally, with 1 consequence being increasing numbers of people affected by dementia, the authors write. It is estimated that the numbers of those with dementia will double every 20 years, to some 81.1 million by 2040, they note.

One question asked frequently in both clinical and policy settings is the impact of dementia on life expectancy, they write. In the present study, the authors examined overall survival for people with dementia, as well as the association between factors that could affect survival in incident cases of dementia over a 14-year follow-up.

MRC CFAS is a multicenter, longitudinal, prospective population-based epidemiological study of cognitive function and disability in England and Wales, including 2 urban and 3 rural centers. The study included 13,004 individuals aged 65 years or older who were drawn from primary care population registers; at each study visit, information on sociodemographic factors, cognitive function, health conditions, and self-reported health were recorded. Participants were enrolled and followed over time for dementia status and mortality.

Of 438 subjects who developed dementia between 1991 and 2003, 356, or 81%, had died by December 2005.

The estimated median survival time from the onset of dementia to death was 4.5 years for the overall population but slightly longer for women than men, with a median survival of 4.6 vs 4.1 years.

Age at onset of dementia had a significant effect on survival times; “There was a difference of nearly 7 years in survival between the younger old and the oldest people with dementia,” the authors write.

Estimated Median Survival by Age at Dementia Onset

Disability with dementia was also associated with shorter survival even after other factors were taken into account, the authors note, with an absolute reduction in survival of about 3 years between the most and least disabled. “This does suggest that the frailer individuals are at higher risk even after age is considered,” they write.

Consider Human Worth

In an editorial accompanying the paper, Murna Downs, PhD, from the Bradford Dementia Group, University of Bradford, United Kingdom, and Barbara Bowers, PhD, from the University of Wisconsin School of Nursing, in Madison, point out that this study shows that dementia “is a terminal condition, the course of which unfolds with coexisting age, related impairment, and ill health.”

The present study provides clear evidence that people with dementia need coordinated care and support from a range of professionals and practitioners “from diagnosis to death” to ensure maximum quality of life and prevent unnecessary disability and suffering, they write. Doctors should also be aware of a “growing evidence base for therapeutic intervention and effective support” in achieving those goals.

“In planning care and support, doctors need to pay as much attention to the essential human worth of a person with dementia and their retained capacity for relationships, pleasure, communication, and coping as they do to deficits and dysfunction,” they conclude.

“Our analyses provide robust population-based estimated survival for incident dementia by age, sex, and setting,” the researchers, with senior author Carole Brayne, MD, from the Institute of Public Health, University of Cambridge, United Kingdom, conclude. While some of these findings may seem “self-evident,” the authors write, “they answer questions asked by those caring for and advising people with dementia. We hope the estimates will be valuable to patients, clinicians, carers, service providers, and policy makers.”

The findings, from the Medical Research Council Cognitive Function and Ageing Study (MRC CFAS), were published January 10 in the BMJ.

Doubling Dementia

Life expectancy is increasing globally, with 1 consequence being increasing numbers of people affected by dementia, the authors write. It is estimated that the numbers of those with dementia will double every 20 years, to some 81.1 million by 2040, they note.

One question asked frequently in both clinical and policy settings is the impact of dementia on life expectancy, they write. In the present study, the authors examined overall survival for people with dementia, as well as the association between factors that could affect survival in incident cases of dementia over a 14-year follow-up.

MRC CFAS is a multicenter, longitudinal, prospective population-based epidemiological study of cognitive function and disability in England and Wales, including 2 urban and 3 rural centers. The study included 13,004 individuals aged 65 years or older who were drawn from primary care population registers; at each study visit, information on sociodemographic factors, cognitive function, health conditions, and self-reported health were recorded. Participants were enrolled and followed over time for dementia status and mortality.

Of 438 subjects who developed dementia between 1991 and 2003, 356, or 81%, had died by December 2005.

The estimated median survival time from the onset of dementia to death was 4.5 years for the overall population but slightly longer for women than men, with a median survival of 4.6 vs 4.1 years.

Age at onset of dementia had a significant effect on survival times; “There was a difference of nearly 7 years in survival between the younger old and the oldest people with dementia,” the authors write.

Estimated Median Survival by Age at Dementia Onset

Disability with dementia was also associated with shorter survival even after other factors were taken into account, the authors note, with an absolute reduction in survival of about 3 years between the most and least disabled. “This does suggest that the frailer individuals are at higher risk even after age is considered,” they write.

Consider Human Worth

In an editorial accompanying the paper, Murna Downs, PhD, from the Bradford Dementia Group, University of Bradford, United Kingdom, and Barbara Bowers, PhD, from the University of Wisconsin School of Nursing, in Madison, point out that this study shows that dementia “is a terminal condition, the course of which unfolds with coexisting age, related impairment, and ill health.”

The present study provides clear evidence that people with dementia need coordinated care and support from a range of professionals and practitioners “from diagnosis to death” to ensure maximum quality of life and prevent unnecessary disability and suffering, they write. Doctors should also be aware of a “growing evidence base for therapeutic intervention and effective support” in achieving those goals.

“In planning care and support, doctors need to pay as much attention to the essential human worth of a person with dementia and their retained capacity for relationships, pleasure, communication, and coping as they do to deficits and dysfunction,” they conclude.

“If there’s an overriding message from our study, it’s perhaps that the hemorrhagic risk associated with heparinlike perioperative anticoagulation is greater than previously appreciated, and that it needs to be considered carefully in any risk/benefit analysis that one is doing around an interruption of warfarin for an elective procedure,” Garcia said. “We don’t have good data about the benefit of perioperative heparin, whereas we are getting increasingly more evidence that perioperative heparin certainly comes with a risk.”

Anyway, he observed, the risk of thromboembolic complications during warfarin interruption appears to be quite low, at least in populations like the one his group studied: “outpatients undergoing elective, relatively minor invasive procedures, most of whom had their warfarin interrupted for only brief intervals, three to five days.” Less than one-tenth of the study’s > 1000 patients had received bridge anticoagulation.

The group’s findings, published in the January 14, 2008 issue of Archives of Internal Medicine, are consistent with those of other studies and with current guidelines “proposed by the American College of Chest Physicians, suggesting that low-risk patients may undergo four to five days of warfarin-therapy interruption without bridging therapy.”

Their analysis covered 1293 instances of warfarin interruption in 1024 patients who underwent such outpatient procedures as colonoscopy, oral or dental surgery, or ophthalmic surgery. The patients averaged 72 years in age, and most had been on warfarin due to atrial fibrillation or mechanical heart valves or for management of venous thromboembolism. Only 8.3% of cases of warfarin interruption involved bridge anticoagulation therapy, which was nearly always with a low-molecular-weight heparin, according to the authors. Outcomes included the following:

• There were only seven instances of thromboembolism (0.7%) within 30 days of the procedure. The rate was the same after exclusion of patients who received bridge therapy.
• The rate of thromboembolism was 0.4% when the warfarin interruption lasted five days or less and 2.2% for those of seven or more days.
• Six patients (0.6%), including four who had received bridge therapy, suffered a major bleeding complication, defined as hemorrhage that led to death or to hospitalization with a transfusion ≥ 2 U red packed cells or at a “critical” site (including, for example, intracranial or retroperitoneal bleeding).
• Another 17 patients (1.7%), including 10 who had received bridge therapy, experienced “clinically significant, nonmajor bleeding.”

Bleeding complication risk among patients who received or did not receive bridge anticoagulation therapy

“Although our paper doesn’t provide any definitive answers, it questions whether the risk of bridging therapy, even in outpatients, can be justified by the potential benefit,” Garcia said, cautioning that it doesn’t apply to patients undergoing major surgery or are hospitalized for an invasive procedure, whose thrombotic and bleeding risks would likely be higher. Randomized, placebo-controlled trials are now needed, he added, to settle the issue.

The study was funded by Bristol-Myers Squibb. Dr. Garcia has disclosed receiving consulting honoraria and research support from Bristol-Myers Squibb, AstraZeneca, and sanofi-aventis. Coauthor Dr. Elaine M. Hylek (Boston University School of Medicine, Massachusetts) has disclosed having served on advisory boards for Bristol-Myers Squibb and receiving research support from AstraZeneca and Bristol-Myers Squibb.

Clinical Context

Significant uncertainty surrounds the treatment of patients who must discontinue warfarin sodium therapy before an invasive procedure. In part, the uncertainty results from the lack of published information about the risk for thromboembolism associated with short-term interruption of warfarin therapy. The patient and clinician have 3 options: (1) continue warfarin therapy, (2) withhold therapy for some time before (and after) the procedure, or (3) temporarily withhold warfarin therapy while also providing a short-acting (bridging) anticoagulant during the perioperative period. The current guidelines from the American College of Chest Physicians suggest that if the annual risk for thromboembolism is low, warfarin therapy may be held for 4 to 5 days before the procedure without bridging and may be restarted shortly thereafter.

The aim of this study was to assess the frequency of thromboembolism and bleeding in patients whose warfarin therapy was temporarily withheld for an outpatient invasive procedure.

Study Highlights

• In this prospective, observational cohort study, enrollment was conducted from April 4, 2000, to March 6, 2002, and was performed at 101 sites (primarily community-based physician office practices) in the United States.
• A total of 1293 episodes of interruption of warfarin therapy in 1024 low- to intermediate-risk individuals were included.
• The mean (SD) age of the patients was 71.9 (10.6) years; 438 (42.8%) were women.
• The most common indications for anticoagulant therapy were atrial fibrillation (n = 550), venous thromboembolism (n = 144), and mechanical heart valve (n = 132).
• The most common procedures were colonoscopy and oral and ophthalmic surgery. Other reasons for withholding warfarin therapy were epidural injection, prostate biopsy, breast biopsy, and dermatologic procedures.
• The main outcome measures were thromboembolism or clinically significant hemorrhage within 30 days of interruption of warfarin therapy.
• Perioperative heparin or low-molecular-weight heparin was used in 8.3% of cases overall.
• Results demonstrated that 7 (0.7%) patients (95% confidence interval [CI], 0.3% – 1.4%) experienced postprocedure thromboembolism within 30 days; 4 of the thromboembolisms were arterial and 3 were venous.
• Among patients whose warfarin therapy was interrupted for 5 days or less, the proportion experiencing thromboembolism was 0.4% vs 2.2% for those with an interruption interval of 7 days or more.
• None of the 7 patients who experienced thromboembolism received periprocedural bridging therapy.
• 6 (0.6%) patients (95% CI, 0.2% – 1.3%) experienced major bleeding, whereas an additional 17 (1.7%) patients (95% CI, 1.0% – 2.6%) experienced a clinically significant, nonmajor bleeding episode.
• Of these 23 patients who had bleeding episodes, 14 received periprocedural heparin or low-molecular-weight heparin.

Pearls for Practice

• According to the American College of Chest Physicians, current recommendations suggest that if the annual risk for thromboembolism is low, warfarin therapy may be held for 4 to 5 days before the procedure without bridging.
• For many patients receiving long-term anticoagulation who need to undergo a minor outpatient intervention, a brief (≤ 5 days) periprocedural interruption of warfarin therapy is associated with a low risk for thromboembolism and bleeding.

A meticulous survey of studies found that the two drug classes are about equally safe and effective at managing high blood pressure and have similar effects on other risk factors and clinical outcomes in patients with essential hypertension [1]. It also confirmed that ARBs are less likely to cause coughing, but suggested that the side effect might be less common with ACE inhibitors than randomized trials indicate.

In the setting of chronic kidney disease (CKD), concludes the other study, which is a meta-analysis, ACE inhibitor and ARB monotherapy are similarly effective at reducing proteinuria, but a combination of the two angiotensin-2-suppressing drugs works better than either agent individually [2]. But a blanket recommendation to combine them would be premature, according to the authors, because there is little evidence that the combination would improve clinical outcomes over monotherapy, and the safety of such combination therapy is largely undefined.

The authors of both analyses acknowledge that they have major limitations, particularly the heterogeneity of the combined studies, their limited follow-up times, and spotty data on adverse effects.

“The most important contribution of these systematic reviews is that they tell us what we do not know,” notes an accompanying editorial [3]. They suggest that the two drug classes are comparably effective as antihypertensive and antiproteinuric agents, writes Dr Patrick S Parfrey (Memorial University of Newfoundland, St John’s), but “we know far too little about their long-term safety, especially with combination therapy of ACE inhibitors plus ARBs in stage 3 or 4 chronic kidney disease.”

No “clinically meaningful difference” in hypertension

“With the exception of rates of cough, the available evidence does not strongly support the hypothesis that ACE inhibitors and ARBs have clinically meaningful differences in benefits or harms for individuals with essential hypertension,” according to the report’s authors, led by Dr David B Matchar (Duke Center for Clinical Health Policy Research, Durham, NC).

He and his colleagues analyzed 69 reports based on 61 randomized and observational studies that lasted at least three months and directly compared an ACE inhibitor and an ARB in adults with essential hypertension and evaluated meaningful end points like blood pressure control, treatment compliance, and adverse events.

The strength of evidence was considered high for the observation that the two drug classes are similarly effective at controlling blood pressure. They were comparable in 37 of the 50 studies evaluated for that outcome; 47 of those 50 studies were randomized controlled trials (RCTs).

Also similar were the associated rates of death and cardiovascular (CV) events, quality-of-life measures, successful use of the ACE inhibitor or ARB as the only antihypertensive agent, effects on lipid levels and left ventricular (LV) mass, and risk of dysglycemia or renal dysfunction.

Mortality and CV-event outcomes were available for only nine studies, most of which excluded patients with clinically significant CV disease or comorbidities, the group reported. Few of the studies followed patients for even as long as a year, and “there were really very limited data about major events, such as heart attack and stroke,” Matchar told heartwire.

The two drug classes showed similar risks of headache and dizziness, but ACE inhibitors were about three times more likely to have cough as a side effect, regardless of whether the study was cohort-based or an RCT. But the rates of cough were “dramatically higher” in the RCTs, probably because in RCTs, in contrast to cohort-based studies, patients are more likely to be queried specifically for that side effect, Matchar said.

Rate of cough as a side effect of ACE inhibitor and ARB therapy

ARB = angiotensin receptor blocker

Other evidence suggested that patients are more likely to stick with ARBs than with ACE inhibitors when each were given as initial therapy, but “the magnitude of this difference is difficult to quantify,” according to the report.

Although any differences in efficacy between the two drug classes are likely to be small, according to Matchar et al, pinning down such small differences might be worth the challenge of mounting a large long-term randomized study, given that small changes in blood pressure are known to have a substantial outcomes effect.

To heartwire Matchar said, “if there really is a marginal benefit to be had from, say, greater tolerability of ARBs compared with ACE inhibitors, then we really do need some [more definitive] head-to-head studies to show it.”

“Encouraging” support for combination therapy in CKD

The other reported study provided “high-quality evidence” that monotherapy with ACE inhibitors or ARBs reduces proteinuria to comparable degrees in patients with CKD, regardless of the underlying cause of renal dysfunction. And, write the authors, led by Dr Regina Kunz (University Hospital, Basel, Switzerland), “evidence is encouraging that the combination of the two drugs is more effective, at usual doses, than either drug alone.”

The group analyzed 49 RCTs that compared ARBs with ACE inhibitors, a combination of the two drug classes, placebo, or calcium-channel blockers and tracked microalbuminuria and proteinuria over at least four weeks in patients with CKD.

ARBs and ACE inhibitors were similarly effective at lowering proteinuria, ARBs were more effective than calcium-channel blockers, and a combination of ARBs and ACE inhibitors was more effective than either agent alone.

Ratio of means (95% CI)* for change in proteinuria, by randomized therapy, over two follow-up intervals

ACE-I = angiotensin-converting-enzyme inhibitor; ARB = angiotensin-receptor blocker; CCB = calcium-channel blocker
*Ratio of means = ratio of the average treatment effect in the intervention group (either ARBs alone or in combination with ACE inhibitors) relative to the control group (placebo or single-drug comparator), with 95% CI

Only one-third of the reports included details on how adverse drug effects were assessed in the studies; according to the authors, few “presented adverse drug reactions in a structured manner that allowed us to make causal inferences,” and 45 of the 49 studies “lacked quantitative data even on more common but less severe adverse drug reactions, prohibiting a reliable estimate of their incidence.”

According to Parfrey, the editorialist, the findings from Kunz et al, along with those of the recent Irbesartan in the Management of PROteinuric patients at high risk for Vascular Events (IMPROVE) trial [4], suggest that “monotherapy with inhibitors of the renin-angiotensin system is sufficient for patients with early-stage renal disease and relatively low albumin excretion and that combination therapy is effective for patients with heavier proteinuria.” However, he cautions, “for combination therapy, we have no safety data in chronic kidney disease, and we do not know the rates of progression of chronic kidney disease. . . . We need a large-scale, long-term, head-to-head, three-group RCT comparing monotherapy with ARBs or ACE inhibitors and with combination therapy involving both ARBs and ACE inhibitors.”

The report by Matchar et al notes that coauthor Dr Douglas C McCrory (Duke Center for Clinical Health Policy Research) has received honoraria from AstraZeneca and coauthor Dr Gregory P Samsa (Duke Center for Clinical Health Policy Research) holds Pfizer stock or stock options. The article by Kunz et al says that “meetings, literature search, and statistical analysis were supported in part by Novartis” and that coauthor Dr Johannes F E Mann (Munich General Hospital, Germany) has received honoraria from Boehringer-Ingelheim, Novartis, and Aventis and grants from Aventis and Novartis.

Clinical Context

More than 65 million Americans have hypertension, and it is the leading attributable risk factor for death throughout the world. According to the editorialist of the 2 studies reviewed, drugs affecting the rennin-angiotensin system are effective in several important diseases including essential hypertension and chronic renal disease, and ACE inhibitors and ARBs both affect angiotensin II, with potential for efficacy alone or in combination in both diseases.

The 2 studies comprise a meta-analysis of 61 studies comparing the effectiveness of ACE inhibitors and ARBs in adults with essential hypertension, and a systematic review of 49 RCTs examining short-term and longer-term outcomes of ACE inhibitors and ARBs for proteinuria in patients with chronic renal disease.

Study Highlights

• Matchar and colleagues (essential hypertension)
  • Included were studies that directly compared ACE inhibitors and ARBs of any design (RCTs, controlled trials, nonrandomized trials, cohort and case control studies) lasting at least 12 weeks and enrolling at least 20 patients, which provided direct comparison of ACE inhibitors and ARBs.
  • Outcomes examined were blood pressure control, adherence, quality of life, intermediate outcomes, and harms.
  • Of 61 studies analyzed, 47 were RCTs, 9 were retrospective cohort studies, 1 cross-sectional, 1 case control cohort, and 1 nonrandomized trial.
  • Rates of use as monotherapy were similar for the 2 classes of drugs.
  • ACE inhibitors and ARBs had similar efficacy for blood pressure control, with no significant differences in benefits or harms (strength of evidence: high).
  • Quality-of-life measures and adherence were similar for ACE inhibitors and ARBs.
  • There were no consistent differential effects seen for death and cardiovascular events.
  • Both classes of medication had similar effects on lipid levels, left ventricular mass, and risk for dysglycemia or renal dysfunction.
  • Adverse effects of headache and dizziness were similar for the 2 classes.
  • Cough as an adverse effect was 3 times more common with ACE inhibitors, with overall rates much higher in randomized trials (9.9% vs 3.2%) vs cohort-based studies (1.7% vs 0.6%).
  • The number needed to treat to cause 1 case of chronic cough for ACE inhibitors was 15.
  • The average duration of follow-up exceeded 6 months in only one third of the head-to-head studies, and there was a lack of long-term studies.
  • There was a lack of adequate studies reporting adverse effect profile of both medication classes.
• Kunz and colleagues (chronic renal disease)
  • Included were RCTs of short-term (1 to 4 months) and longer-term (5 to 12 months) studies involving a total of 6181 patients with microalbuminuria and proteinuria of diabetic origin and other causes and reported changes in proteinuria during follow-up.
  • Trials were at least 4 weeks in duration with parallel group or crossover designs.
  • Excluded were studies of patients who had renal transplantation and those with less than 10 participants.
  • Of 49 RCTs, 12 compared ARBs with placebo, 9 with calcium-channel blockers, 23 with ACE inhibitors, and 16 with the combination of ACE inhibitors and ARBs.
  • 23 trials compared combination ARBs and ACE inhibitors with an ACE inhibitor alone.
  • Monotherapy with ACE inhibitors or ARBs reduced proteinuria to a similar degree but less than combination therapy.
  • Mean reduction in proteinuria with combination vs ARB monotherapy in 5- to 12-month studies was 0.75 vs 0.82 (ratio of means) with ACE inhibitors.
  • Monotherapy with ARBs reduced proteinuria vs placebo, with a ratio of means of 0.57 in 1 to 4 months and 0.69 in 5 to 12 months.
  • Results were similar for ACE inhibitors and ARBs vs calcium-channel blockers.
  • 92% of studies lacked quantitative data on adverse drug reactions.
  • In the absence of safety data on long-term combination therapy with ACE inhibitors and ARBs, therapy should be limited to those with stage 3 or 4 disease with close monitoring of potassium levels.
  • The editorialist concluded that monotherapy with ACE inhibitors or ARBs was sufficient treatment for early-stage renal disease with relatively low albumin exertion, and combination therapy was effective for patients with heavier proteinuria when monotherapy failed to decrease 24-hour urinary protein excretion to less than 0.5 g.

Pearls for Practice

• ACE inhibitors and ARBs are equivalent in efficacy for the treatment of essential hypertension, and ACE inhibitors are associated with a 3 times higher rate of chronic cough.
• ACE inhibitors and ARBs are similar in efficacy for the treatment of proteinuria of chronic renal disease, with the combination being more effective than monotherapy with either drug, but long-term adverse effects are not well documented.

“Dietary intake of specific nutrients or food groups during pregnancy could play a role in the risk of asthma and atopy in offspring, but specific dietary patterns have not been implicated,” write Leda Chatzi, MD, PhD, from the University of Crete in Heraklion, Greece, and colleagues. “In general, the Mediterranean diet is characterised by elevated intake of plant foods such as fruits and vegetables, bread and cereals (primarily wholegrain), legumes and nuts. Low to moderate amounts of dairy products and eggs, and only little amounts of red meat are included in the diet. This dietary pattern is low in saturated fatty acids, rich in carbohydrates, fibre and antioxidants, and has a high content of monounsaturated fatty acids and n-3 polyunsaturated fatty acids, which are primarily derived from olive oil and fish intake.”

The investigators recruited women presenting for antenatal care at all general practices in Menorca, a Mediterranean island in Spain, during a 12-month period beginning in mid-1997. After 6.5 years of follow-up, 460 children were included in the analysis. Food frequency questionnaires were used to evaluate maternal dietary intake during pregnancy and children’s dietary intake at age 6.5 years, and a priori defined scores evaluated adherence to a Mediterranean diet. Follow-up included parental questionnaires on the child’s respiratory tract and allergic symptoms, as well as skin prick tests, with 6 common aeroallergens, for the children.

At age 6.5 years, prevalence rates were 13.2% for persistent wheeze, 5.8% for atopic wheeze, and 17.0% for atopy. According to the Mediterranean Diet Score during pregnancy, one third (36.1%) of mothers had a low-quality Mediterranean diet, and the rest had a high-quality Mediterranean diet.

After adjustment for potential confounders and use of the “low” score as the reference, a high Mediterranean Diet Score during pregnancy was found to be protective for persistent wheeze (odds ratio [OR], 0.22; 95% confidence interval [CI], 0.08 – 0.58), atopic wheeze (OR, 0.30; 95% CI, 0.10 – 0.90), and atopy (OR, 0.55; 95% CI, 0.31 – 0.97) at age 6.5 years.

Adherence to a Mediterranean diet during childhood was negatively associated with persistent wheeze and atopy, but this did not reach statistical significance.

“Our results support a protective effect of a high level of adherence to a Mediterranean diet during pregnancy against asthma-like symptoms and atopy in childhood,” the study authors write.

Limitations of the study include no information on maternal food allergy, and parental reports on children’s diet and symptoms creating possible information bias.

“Further studies are needed to better understand the mechanisms of this protective effect and the most relevant window of exposure,” the study authors conclude. “Further follow-up of this cohort will allow determining if this protective effect persists in older children.”

This study was supported by the Instituto de Salud Carlos III red de Grupos Infancia y Media Ambiente, the Fundacio “La Caixa,” the Instituto de Salud Carlos III, red de Centros de Investigacion en Epidemiologia y Salud Publica and EU grant NewGeneris. One of the study authors has received support in part from the National Center for Environmental Health – Centers for Disease Control and Prevention, Atlanta, Georgia; the GA2LEN project; and the Ministry of Education and Science, Spain. Another study author has received support from the Oficina de Ciencia y Tecnología, Generalitat Valenciana.

Thorax. Published online January 15, 2008.

Clinical Context

Dietary habits seem to play a role in the risk for wheezing and atopy. According to Romieu and colleagues in the April 2007 issue of Clinical and Experimental Allergy, fish intake during pregnancy was linked to a lower risk for eczema, atopy, and atopic wheeze in the offspring. In the June 2007 issue of Thorax, Garcia-Marcos reported that a Mediterranean diet in female children seemed to protect against severe asthma.

In the November 1997 issue of Nutrition Reviews, Trichopoulou described a Mediterranean diet: high intake of fruits, vegetables, wholegrain bread and cereals, legumes, and nuts; low to moderate dairy products and eggs; and low intake of red meat. Overall, there is low intake of saturated fatty acids and high intake of fiber, antioxidants, monounsaturated fatty acids, and n-3 polyunsaturated fatty acids (from fish and olive oil).

This cohort study of pregnant women and their offspring from Menorca, a Mediterranean island in Spain, evaluates whether adherence to a Mediterranean diet during pregnancy and childhood affects the prevalence of asthma-like symptoms and atopy in the children.

Study Highlights

• 507 pregnant women in a Mediterranean region were recruited in a 12-month period.
• Data were available for 468 of their offspring at age 6.5 years.
• 8 children were excluded because of total energy intake values less than 800 kcal/day or more than 3000 kcal/day.
• Parents were interviewed every year about the child’s medical conditions in the previous 12 months.
• Demographic data were obtained during pregnancy and at the child’s age of 6.5 years.
• 415 (90.2%) children had height and weight data at age 6.5 years.
• For assessment of childhood dietary intake at age 6.5 years, a 96-item food frequency questionnaire and point values for Mediterranean-related foods (vegetables, legumes, fruits, nuts, cereal, fish, dairy products, olive oil) and non–Mediterranean-type foods (sweets, fast foods) were used to categorize diet as optimal, medium-quality, or low-quality Mediterranean.
• For assessment of maternal dietary intake during pregnancy, a 42-item food frequency questionnaire and point system for Mediterranean-type foods were used to categorize diet as high or low in Mediterranean diet quality.
• Primary outcome measures at age 6.5 years were persistent wheeze (defined by at least 1 episode of “whistling or wheezing from chest, but not noisy breathing from nose” in the previous 12 months and preceding years), atopic wheeze (current wheeze and atopy), and atopy (skin prick test).
• Skin prick testing was conducted on 412 (89.6%) children at age 6.5 years.
• Adjustment was made for possible confounding factors: sex, parental asthma, maternal factors (atopy, age at pregnancy, social class, education, smoking during pregnancy, supplement use during pregnancy), breast-feeding, lower respiratory tract infections at age 1 year, birth weight, gestational age, birth order, number of siblings, and body mass index at age 6.5 years.
• Childhood adherence to a Mediterranean diet was low quality for 9.3%, intermediate for 53.7%, and high for 37.0%.
• Maternal adherence to a Mediterranean diet was low quality for 36.1%.
• At age 6.5 years, 13.2% of children had persistent wheeze, 5.8% had atopic wheeze, and 17.0% had atopy.
• High level of childhood adherence to a Mediterranean diet was not significantly associated with wheeze, atopic wheeze, and atopy at age 6.5 years.
• High level of maternal adherence to a Mediterranean diet during pregnancy was protective for all outcome measures in children at age 6.5 years:
  
  • Persistent wheeze (OR, 0.23; 95% CI, 0.09 – 0.60)
  • Atopic wheeze (OR, 0.34; 95% CI, 0.12 – 0.97)
  • Atopy (OR, 0.55; 95% CI, 0.32 – 0.97)
• Lower risk for childhood wheeze was associated with maternal intake of certain foods:
  
  • Vegetables more than 8 times per week (OR, 0.36; 95% CI, 0.14 – 0.92)
  • Fish more than 2.5 times per week (OR, 0.34; 95% CI, 0.13 – 0.84)
  • Legumes more than once per week (OR, 0.36; 95% CI, 0.13 – 1.01)
• Lower risk for childhood atopy was associated with maternal intake of vegetables more than 8 times per week.
• Maternal adherence to a Mediterranean diet was linked with childhood adherence to a Mediterranean diet.

Pearls for Practice

• Maternal adherence to a Mediterranean diet during pregnancy is linked to a lower risk for persistent wheeze, atopic wheeze, and atopy in the offspring during childhood.
• Adherence to a Mediterranean diet during childhood does not significantly affect the risk for persistent wheeze, atopic wheeze, and atopy in childhood.