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Articles by W. D. Fraser
Total Records ( 2 ) for W. D. Fraser
  H. D White , A. A Joshi , A. M Ahmad , B. H Durham , J. P Vora and W. D. Fraser
  Background

Difficulties associated with measuring ionized calcium in clinical practice have led to the use of total calcium, with or without adjustment for albumin concentration, as an estimate of calcium metabolism. We examined the correlation between ionized and total/adjusted calcium over a 24-h period in patients with adult growth hormone deficiency (AGHD), a group of patients with previously reported alterations in calcium metabolism.

Methods

Four patients with AGHD were consented to the study. They were hospitalized for 24 h where half-hourly blood samples were collected for ionized calcium, total calcium, albumin and creatinine, before and one month after the commencement of growth hormone replacement. Total calcium concentration was adjusted for serum albumin.

Results

Strong correlations were found between ionized calcium and adjusted calcium (r2 = 0.840 and 0.766 for visits 1 and 2, respectively, P < 0.001), and between ionized calcium and total calcium (r2 = 0.828 and 0.731 for visits 1 and 2, respectively, P < 0.001). Correlations remained significant during the day (ionized versus adjusted calcium: r2 = 0.847 and 0.780 for visits 1 and 2, respectively; ionized versus total calcium: r2 = 0.860 and 0.792 for visits 1 and 2, respectively, all P < 0.001) and at night (ionized versus adjusted calcium: r2 = 0.831 and 0.802 for visits 1 and 2, respectively; ionized versus total calcium: r2 = 0.767 and 0.722 for visits 1 and 2, respectively, all P < 0.001).

Conclusion

The results of our study suggest that total calcium and serum-adjusted calcium can be used in place of ionized calcium as a reliable indicator of calcium metabolism over a 24-h period in patients with AGHD.

  Z. C. Luo , F. Simonet , S. Q. Wei , H. Xu , E. Rey and W. D. Fraser
  Aim  We tested the hypothesis that diabetes in pregnancy may differentially affect neonatal outcomes in twin vs. singleton pregnancies. Methods  In a retrospective cohort analysis of twins (n = 422 068) and singletons (n = 14 298 367) born in the USA from 1998 to 2001, we evaluated the adjusted odds ratios of adverse neonatal outcomes comparing diabetic vs. non-diabetic pregnancies, controlling for maternal characteristics. Primary outcomes include macrosomia (birthweight for gestational age > 90th percentile), congenital anomalies, low 5-min Apgar score (< 4) and neonatal death. Results  Diabetes in pregnancy was associated with a similarly increased risk of congenital anomalies (adjusted odds ratios 1.52 vs. 1.59) and smaller increased risks of preterm birth (adjusted odds ratios 1.27 vs. 1.49) and macrosomia (adjusted odds ratios 1.38 vs. 2.03) in twins vs. singletons, but reduced risks of low 5-min Apgar score (adjusted odds ratio 0.74) and neonatal death (adjusted odds ratio 0.76) in twins but not singletons. Conclusions  Diabetes in pregnancy may differentially affect neonatal outcomes in twins and singletons, indicating a need for further studies to differentiate the effects by clinical subtypes of diabetes in pregnancy, and to consider/evaluate differential clinical management protocols of diabetes in multiple vs. singleton pregnancies.
 
 
 
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