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COVID-19 caused by SARS-CoV-2 infection is a highly contagious disease affecting both the higher and lower portions of the respiratory tract. This disease reached over 265 million people and has been responsible for over 5.25 million deaths worldwide. Skeletal muscle quality and total mass seem to be predictive of COVID-19 outcome. This systematic review aimed at providing a critical analysis of the studies published so far reporting on skeletal muscle mass in patients with COVID-19, with the intent of examining the eventual association between muscle status and disease severity. A meta-analysis was performed to evaluate whether skeletal muscle quantity, quality and function were related to disease severity. Systematic reviews and meta-analyses were conducted according to the guidelines of the Cochrane Handbook for Systematic Reviews of Interventions and reported according to the guidelines of the PRISMA (Preferred Reporting Items for Systematic Reviews and Meta-Analysis) guide. From a total of 1,056 references found, 480 were selected after removing duplicates. Finally, only 7 met the specified inclusion criteria. The results of this meta-analysis showed that skeletal muscle quality, rather than quantity, was associated with COVID-19 severity, as confirmed by lower skeletal muscle density and lower handgrip strength in patients with severe disease. Muscle function assessment can thus be a valuable tool with prognostic value in COVID-19.

BACKGROUND: Weight loss and body composition changes are common in patients with pancreatic cancer. Computed tomography (CT) images are helpful to investigate body composition and its changes and to discriminate the different kinds of body tissues. Patients with pancreatic cancer routinely undergo CT scans. OBJECTIVE: To verify the association of muscle mass and visceral fat measured by CT with toxicity and survival of patients with pancreatic cancer. METHODS: We evaluated the imaging of the abdomen of all consecutive adult patients with pancreatic cancer treated between October 2007 and September 2015 in our service, to assess skeletal muscle mass and fat, intramuscular fat and visceral fat. We graded treatment toxicity symptoms according to the Common Toxicity Criteria of the United States National Cancer Institute (version 2.0). RESULTS: The study involved 17 patients, with a mean age of 63 (±10) years (range: 51-73 years). Eleven (65%) were male. The mean initial body mass index (BMI) was 26 kg/m2 (±3) and 23 kg/m2 (±3) after treatment. The mean weight loss was 10.0 kg (±6.8; 13%). Sarcopenia was present in 47% of patients, and it was not associated with significant differences in muscle mass, visceral fat, toxicity or survival. The mean skeletal muscle attenuation was 36 Hounsfield units, not associated with survival or treatment toxicity. Mean muscle mass was not associated with toxicity either. However, there was a significant inverse association between toxicity and visceral fat. CONCLUSION: Muscle mass had no impact on the survival or on treatment toxicity among the patients with pancreatic cancer. However, the visceral fat exerted a protective effect against the treatment toxicity. We stress the importance of further studies on visceral fat associated with prognosis and toxicity in cancer patients.

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Introduction There are few studies on the behavior of vitamin D in patients undergoing Hematopoietic Stem Cell Transplantation (HSCT), although vitamin D serum levels are associated with use of corticosteroids and immunosuppressive drugs. In some studies, vitamin D deficiency in patients after HSCT is associated with reduced bone density, increased of parathyroid hormone and GVHD. Objectives To study vitamin D deficiency in patients undergoing to HSCT. Methods 51 patients who underwent HSCT at Albert Einstein Hospital, São Paulo, Brazil, were studied (28 male, 23 female) with a mean age of 50 ± 16 years, in the period from 2012 to 2013. Results 54 % had serum levels of vitamin D ≤ 50 nmol/l. And, 12% had serum levels of vitamin D ≤ 25 nmol/l. A multivariate analysis showed that more age and higher Body Mass Index (BMI) were significantly associated to lower serum levels of vitamin D. A negative correlation was found between BMI and serum level of vitamin D (rp=0,37). Conclusion The use of corticosteroids, immunosuppressive drugs and less lack of sun exposure during the HSCT and during the first year post-HSCT are associated with a greater tendency to deficiency of vitamin D. This deficiency can cause muscle and bone diseases, which can be prevented with diagnosis and early treatment. The deficiency of vitamin D should be carefully investigated in the elderly and obese patients. Disclosures: No relevant conflicts of interest to declare.

Introduction: Patients undergoing Hematopoietic Stem Cell Transplantation(HSCT) may have low vitamin D (VD) level because of decreased exposure to sunlight, the major cause of VD Deficiency (VDD), from prolonged hospital stays, limited outdoor activity, and sunscreen use, and decreased oral intake caused by gastrointestinal treatment toxicity. Besides that gastrointestinal graft-versus-host disease (GVHD) limit absorption of VD. Some medications received during the HSCT can increased the VD catabolism, and alterate renal and kidney function. Objectives: To evaluate the reduction of number of patients with VD Deficiency in patients undergoing HSCT after educational classes for the multi-professional team (physicians, dietitians and nurses). Methods: We analyzed 72 patients undergoing HSCT May 2012 to January 2014 in the Hematology-Oncology and Bone Marrow Transplantation Center at Albert Einstein Hospital in São Paulo, Brazil. The serum levels of vitamin were measured in the first day of hospitalization of the patients adults (>= 18 years) who would be undergoing HSCT. All types of HSCT patients were included.We used in our study the VDD was defined and recommended by the Institute of Medicine as a 25(OH)D <=20 ng/ml, VD insufficiency of 21-29 ng/ml, and VD normal >=30 ng/ml.In the 2012 the multi-professional HSCT Team had 3 classes about VD and, everyone were informes about the VD research protocol. Results: 72 adult patients were observed in this study, aged between 18 and 74 years, with the majority (77.8%) with less than 65 years. Of the total, 59.7% were men and 41.7% had normal body mass index. 100% of the lymphoma patients had VDD. In 2012(n:33), 60% patients had VDD and in 2013 (n:39), 40% (p<0,05). Conclusions: When all of members of HSCT team were informed about the benefits of high VD levels in patients undergoing HSCT by classes and research protocol, we can reduce VDD. Disclosures No relevant conflicts of interest to declare.

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Introduction: Hematopoietic stem cell transplantation (HSCT) may improve outcomes of patients with hematologic malignancies not curable with conventional therapies. Being in some diseases the only curative option. HSCT in elderly patients with good performance status and no comorbidities could, in fact, not only survive the transplant with reasonable risk, but also benefit in the same measure as younger patients. Objectives: To study and correlate nutrition and geriatric assessment in elderly patients undergoing HSCT. Methods: A retrospective study of 17 elderly patients (>60 years) undergoing HSCT May 2012 to January 2014 in the Hematology-Oncology and Bone Marrow Transplantation Center at Albert Einstein Hospital in São Paulo, Brazil. All patients were evaluated approximately one month prior to HSCT. In the geriatric assessment were done hand-grip strength(HGS), questions about mobility and functional limitation. In the nutrition, we studied the Body Mass Index(BMI) (kg/m2), and serum levels of vitamin D, zinc and albumin. Results: 17 elderly patients were observed in this study, mean age was 65,5±3,8 years, BMI was 28±6,0 kg/m2, HGS was 28±8,5 kg; serum levels of albumin 3,2±0,5g/dl(normal:3,5-5,0); serum level of vitamin D 23,4±14 ng/ml (normal >20); serum levels of zinc 65,5±18 mg/dl (normal: 66-132,5 mg/dl). We found the negative correlation between BMI and HGS (rp=0,42). There were a significant and positive association between serum levels of zinc and albumin, and HGS and grades of mobility questions(p<0,05). The serum levels of vitamin D weren`t significantly associated with geriatric factors. Conclusion: Our study showed that the obese patients with more risks of complications in HSCT had more functional limitation. Besides low levels of zinc and albumin were associated with worst results in the geriatric assessment. In the elderly the immobility and weakness can increased the complications after HSCT. The geriatric and nutrition assessment are important to improve HSCT results. Disclosures No relevant conflicts of interest to declare.