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Nutritional Rickets β deficiency of Vitamin D leading to impaired bone mineralization.
Pathophysiology:
\[\downarrow \text{Vit D} \Rightarrow \downarrow \text{Ca}^{2+}\,\text{absorption (gut)} \Rightarrow \downarrow \text{Serum Ca}^{2+} \Rightarrow \uparrow \text{PTH} \Rightarrow \downarrow \text{Phosphate (renal loss)} \Rightarrow \text{Impaired mineralization}\]
Clinical features:
- Rachitic rosary: Bony swellings at costochondral junctions
- Harrison's sulcus: Horizontal groove along lower chest (diaphragm pull)
- Craniotabes: Ping-pong ball sensation (skull)
- Bossing: Frontal bossing
- Widened wrists/ankles
- Bow legs (genu varum) or knock knees
- Delayed dentition, hypocalcemic tetany
Labs: \(\downarrow\) Ca, \(\downarrow\) POβ, \(\uparrow\) ALP (markedly), \(\uparrow\) PTH, \(\downarrow\) 25-OH Vitamin D
X-ray: Cupping, fraying, splaying of metaphyses (especially distal radius)
Treatment: Vitamin D \(1000{-}5000\,\text{IU/day}\) for 3 months + calcium supplementation.
Calculation of oxidation states:
- $[Cr(C_{6}H_{6})_{2}]$: Benzene is a neutral ligand, so $Cr$ is in $0$ oxidation state.
- $[Cr(H_{2}O)_{6}]Cl_{3}$: $H_{2}O$ is neutral and there are 3 $Cl^{-}$ ions, so $x + 0 = +3 \Rightarrow x = +3$.
- $K_{2}[Cr(CN)_{2}(O)_{2}(O_{2})(NH_{3})]$: $K$ is $+1$, $CN$ is $-1$, $O$ (oxo) is $-2$, $O_{2}$ (peroxo) is $-2$, and $NH_{3}$ is $0$. $2(+1) + x + 2(-1) + 2(-2) + (-2) + 0 = 0 \Rightarrow x = +6$.
The tenure of the US President is:
The US President is elected for a four-year term and can serve a maximum of two terms.
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