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Dr K K Aggarwal

1.       One needs to distinguish between Paraphiliac and non-paraphiliac rapists. Paraphiliac rapists have excessive sexual desire. Paraphiliac offenders commit sex offences because they are sexually aroused by the act. On the other hand, non-paraphiliac sex offenders are instigated by violations or ego-hurt or for taking revenge.

2.       False allegations of rapes can occur in situations like: if one of the partners in live-in relationship refuses to marry, if two consensual partners are caught in the sexual act by the society, someone exploits secrete of the other person.

3.       Under the influence of alcohol one loses intellect and may end up in raping somebody if instigated.

4.       Chemical castration is reversible and the effect of the injection lasts only 3-6 months. The injections are costly and need to be given by medical doctors.

5.       Chemical castration in the long run leads to thinning of the bone (osteoporosis), feminine characteristic and increased tendency for cardiovascular diseases.

6.       Chemical castration drugs are not safe and healthy.

7.     In long run influential people convicted for chemical castration will start paying bribes to doctors and get a water injection in place of chemical castration injection.

8.       Chemical castration does not mean dissolving the male organ with a chemical. It only means reducing the blood testosterone levels to that of pre-puberty levels.

9.        Non-injectible oral drugs which block the action of testosterone are costlier and need to be taken every day. Therefore, they cannot be a part of chemical castration as punishment.

10.       Surgical removal of testis will remove sexual desire permanently and the same can only be given as a punishment in patients who are spending life-term in the prison.

11. Depoprovera is another injection which can be given every three months to patients with paraphiliac sexual abnormality.

12. Deprivation of sex and non-fulfillment of sexual desires is one of the main causes of rapes.

13.   If female commercial sex workers are banned in the society, the incidents of rape will increase as sexually deprived people with strong sexual urges will end up raping the minors.

14.  People under the influence of alcohol and drugs will keep raping the girls if not treated and counseled in time.

Dr K K Aggarwal is Padmashri and Dr B C Roy National Awardee, President Heart Care Foundation of India and National Vice President Elect IMA

Do not ignore yellow plaques on the eyelids

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Xanthelasma are soft, cholesterol–filled plaques that develop under the skin, usually on or around the eyelids and most often near the nose. They occur mainly in middle–aged and older adults and in women more often than in men. They are always benign and rarely impair vision. But they can be a sign of hyperlipidemia—elevated blood–fat levels in 50% of the people.

The presence of xanthelasma on the eyelids is an independent predictor of future heart blockages. In a large prospective study By Dr Anne Tybjærg–Hansen, of Rigshospitalet in Copenhagen published in BMJ during a mean follow–up of 22 years, adults participating in a long–term Danish heart study who had xanthelasmata at baseline had an adjusted hazard ratio for acute heart attack of 1.48. In the study those with the eyelid lesions had lower levels of apolipoprotein A1 and HDL cholesterol as against those who had arcus corneae they had higher levels of lipoprotein (a).

The plaques are especially common in people with inherited disorders of low–density lipoprotein (LDL) metabolism. They occur in 75% of older people with familial hypercholesterolemia (very high cholesterol levels) and in 10% of people with high levels of apolipoprotein B.

Treating any underlying lipid condition may reduce the size of xanthelasma. If no lipid abnormality is present then xanthelasma is largely a cosmetic problem.

There are several ways to remove xanthelasma. These include cryotherapy (freezing the lesions with liquid nitrogen), laser ablation, surgical excision, electrodesiccation (destruction of the lesion with an electric needle), and chemical cauterization (application of a topical agent such as trichloroacetic acid to dissolve the plaques).

Take home message

  • All patients with xanthelasmas should get lipid profile done.
  • Look for low HDL and low Apo A1 levels.
  • Look of high Apo B levels.
  • Get LP(a) levels it will usually be normal.