The Furlow technique as originally described has shortcomings. The authors describe their technique of incorporating the Furlow repair, which enables them to use it as a primary palatoplasty, in a scenario consisting of a large percentage of wide clefts in an older age group, thereby minimizing the fistula rate while increasing palatal length.

Objectives: There has been a rapid increase in respiratory infections due to COVID-19, caused by SARS-CoV-2, a novel coronavirus, which is believed to have originated from Wuhan in China. The disease has taken a form of pandemic and is now present in all countries across the globe with nearly 5.4 million infections and 344,000 fatalities till date. In late March, the Indian government initiated a lockdown, which confined nearly 1.3 billion people, around one-sixth of humanity to home, in an effort to decrease the community transmission of COVID-19 disease and flatten the curve so that Indian health care is able to deal with a manageable number of cases. This lockdown, which started on March 25, 2020, has now been extended to May 17, 2020, a duration of 54 days, with further planned extension to May 31. During this lockdown, the authors noted an increase in the number of mixer grinder injuries and a change in the demography of suicidal attempts due to frustration resulting in injuries to upper limb. The authors have studied this phenomenon and compared the data with cases from previous year. Material and Methods: The case records of all patients coming to the emergency department and department of plastic surgery in the period of March 25, 2020, to May 17, 2020 (54 days), with injuries of upper limb were analyzed and data compared with data from 2019. The demography and mode of injuries were studied. Results: There was an unusual increase in hand injuries due to mixer grinder in kitchen, 32 cases in 54 days (17.78/month) compared to 28 cases in 12 months in 2019 (2.34/month) with P < 0.001. There was also an increase in number of intended self-inflicted injuries in upper limb, as a result of psychological effects of rage and frustration with spouse due to long periods of confinement at home (3.89/month during lockdown period compared to 0.58 during 2019, P < 0.005) with change in demography compared to previous year. There was a decrease in upper limb injuries due to road traffic accidents, industrial accidents, assaults, sports, school, and work-related injuries, during the lockdown period, and this was along the expected lines. Conclusion: The period of lockdown initiated in India, to slow the community transmission of COVID-19 caused long periods of confinement together at home for families and forced the young adults to carry out some unaccustomed work, which resulted in a spike in mixer grinder injuries of hand. It also led to some rage and frustration, especially with spouses with a spike in suicidal attempt upper limb injuries.

Authors in their clinical practice came across transsexual patients, who were determined to get their gender affirmed by undergoing a change of sex. This motivated the authors to review the literature extensively regarding transsexualism and report their experience. Opinions were taken from legal luminaries practicing in related fields. They also took inputs from several patients who were at various stages of psychiatric analysis and hormone therapy and also those, who had completed their treatment procedures. A paucity of the Indian inputs in medical literature concerning transsexualism was noted by the authors They also found deficiencies in the Indian Law, as applied to the individuals undergoing gender affirmation surgery (GAS). In this paper they have enumerated these deficiencies. Though GAS has been legally allowed in U.K. since 1967, in America since 1972, and in various other countries, Indian Laws are silent on the issue. An Indian surgeon dealing with transsexual patients is faced with a number of issues like consent for the procedure, safe guarding the surgeon or gender team from future litigation. Another issue is postoperative sexual and legal status of the patient. Present Indian Laws regarding marriage, adultery, sexual and unnatural offences, adoptions, maintenance, succession, labour and industrial laws will require modifications when dealing with these individuals and protecting their rights. Authors have tried to deal with all these issues that an individual surgeon faces when he manages a transsexual patient.

A mismatch between the birth sex of a person and psychological recognition of self (gender) leads to a gender expression, which is at variance with the societal norms, and thus gives rise to a persistent distress, which is known as gender incongruence (GI) (previously gender dysphoria). These persons are known as trans genders. A subset of these individuals feels that they are trapped in the wrong sexed body and need to bring their physical sex into alignment with their gender. The “gender” is already imprinted into the brain at birth, and hence cannot be changed, but the physical sex of a person can be, through gender affirmation surgeries (GAS). There has been relative paucity of data from India regarding medical and surgical affirmative management of trans-persons, and hence, the authors present their experience in GAS together with current demography, hypothesis regarding etiology and management, as carried out in India. Authors have been providing comprehensive affirmative management to trans persons, through their multi-specialty gender identity clinic (GIC) sited in a tertiary care hospital. Over past 27 years, the senior author has performed over 3,000 GAS. The authors have noticed a 20- fold rise in presentation of these cases (from six cases per year in 1993 to now around 150 cases in the year 2019), an observation, which is similar to the experience of large volume GICs worldwide, as well as many recent publications. There has been a steep rise in the number of persons with GI worldwide, and those reporting at GICs. In the face of this rising number, authors present their experience, together with current demographics and management. Authors have also contributed to the first version of Indian Standards of Care for persons with GI and people with differences in sexual development/orientation Indian standards of care 1in November 2020.