BACKGROUND: There are limited data available to indicate whether oncological outcomes might be influenced by the uterine manipulator, which is used at the time of hysterectomy for minimally invasive surgery in patients with endometrial cancer. The current evidence derives from retrospective studies with limited sample sizes. Without substantial evidence to support its use, surgeons are required to make decisions about its use based only on their personal choice and surgical experience. OBJECTIVE: To evaluate the use of the uterine manipulator on oncological outcomes after minimally invasive surgery, for apparent early-stage endometrial cancer. STUDY DESIGN: We performed a retrospective multicentric study to assess the oncological safety of uterine manipulator use in patients with apparent early-stage endometrial cancer, treated with minimally invasive surgery. The type of manipulator, surgical staging, histology, lymphovascular space invasion, International Federation of Gynecology and Obstetrics stage, adjuvant treatment, recurrence, and pattern of recurrence were evaluated. The primary objective was to determine the relapse rate. The secondary objective was to determine recurrence-free survival, overall survival, and the pattern of recurrence. RESULTS: A total of 2661 women from 15 centers were included; 1756 patients underwent hysterectomy with a uterine manipulator and 905 without it. Both groups were balanced with respect to histology, tumor grade, myometrial invasion, International Federation of Gynecology and Obstetrics stage, and adjuvant therapy. The rate of recurrence was 11.69% in the uterine manipulator group and 7.4% in the nomanipulator group (P<.001). The use of the uterine manipulator was associated with a higher risk of recurrence (hazard ratio, 2.31; 95% confidence interval, 1.27e4.20; P¼.006). The use of uterine manipulator in uterus-confined endometrial cancer (International Federation of Gynecology and Obstetrics [FIGO] IeII) was associated with lower disease-free survival (hazard ratio, 1.74; 95% confidence interval, 0.57e0.97; P¼.027) and higher risk of death (hazard ratio, 1.74; 95% confidence interval, 1.07e2.83; P¼.026). No differences were found regarding the pattern of recurrence between both groups (chi-square statistic, 1.74; P¼.63). CONCLUSION: In this study, the use of a uterine manipulator was associated with a worse oncological outcome in patients with uterusconfined endometrial cancer (International Federation of Gynecology and Obstetrics IeII) who underwent minimally invasive surgery. Prospective trials are essential to confirm these results.

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Introduction: The North Lisbon University Hospital Center was activated for referral of SARS-CoV-2 infected patients on the 11th March 2020. The aim of this study is to describe the experience at the Department of Pediatrics in the approach and the clinical outcomes of infected children.Material and Methods: A descriptive observational study was performed. Children and adolescents (0 to 18 years) with SARS-CoV-2 infection, diagnosed in the emergency room or admitted to the Department of Pediatrics between March 11th and June 18th, were included. Hospital records and Trace COVID-19 platform were reviewed and patient caregivers were interviewed to assess follow up.Results: Among 103 diagnosed children, 83% had a known previous contact with an infected patient, 43% presented fever and 42% presented respiratory symptoms. Ten percent had risk factors and 21% were aged under one year old. Ten percent were hospitalised, one needing intensive care, with paediatric inflammatory multisystem syndrome. Blood tests were performed in 9% and chest radiograph in 7%. No children required ventilation, antiviral therapy or underwent thoracic computed tomography scan. Eight percent of children returned to the emergency room and one child was hospitalised. The clinical outcome is known in 101 patients and is favourable in all.Discussion: Most children had an epidemiological link and little clinical repercussion, even during the first year of life. The expected mild severity in children justified the use of established clinical criteria and recommendations for similar conditions, regarding tests and hospitalizations. No antiviral treatments were given due to lack of evidence of its benefits.Conclusion: This strategy contributed to a low consumption of hospital resources and proved safe in this series.

Subcutaneous fat necrosis of the newborn should be considered in newborns with suggestive skin lesions, even in the absence of perinatal distress. SCFN may cause long‐standing complications, like hypertriglyceridemia or hypercalcemia. Hypercalcemia can be refractory to therapy and lead to poor weight gain and nephrocalcinosis, which should be closely monitored.