COVID-19 and the ABO blood group connection Severe Acute Respiratory Syndrome Coronavirus 2 (SARS-CoV-2), causing the current pandemic of COVID-19, is genetically similar to SARS-CoV that caused the SARS outbreak in 2002. Recently, nextgeneration sequencing of SARS-CoV-2 showed a 99•98 % sequence identity across 9 patients. SARS-CoV-2 showed 79 % similarity to SARS-CoV, with a comparable receptor-binding domain (ACE2) on modeling [1]. Susceptibility of certain viral infections has been linked to antigenic determinants of ABO blood groups. Cheng et al. showed linkage of SARS coronavirus infection with ABO blood groups, where individuals with blood group O were less likely to become infected, compared to non-O blood group individuals (OR 0•18) [2]. Data from Wuhan, China, the first epicenter of COVID-19 pandemic, shows ABO blood group linkage with COVID-19 infections [3]. Zhao et al. compared ABO blood groups of controls from the general population with 2173 COVID-19 patients from three hospitals in Wuhan region. Across all three hospitals, blood group A was associated with a higher risk for COVID-19 (OR 1•21; P = 0•027) compared with non-A blood groups, whereas blood group O was associated with a significantly lower risk for the infection (OR 0•67; P < 0•001) compared with non-O blood groups [3]. Another observational study on data from New York Presbyterian hospital system, on 1559 individuals tested for SARS-CoV-2 with known blood type, also showed similar results. In SARS-CoV-2 positive cases, there was a high proportion of blood group A, with a low proportion of blood group O [4]. With regards to the case fatality rate, as mentioned by Zhao et al., blood group A was also linked to higher mortality risk in contrast to blood group O (OR 1•482; P = 0•008), the latter was associated with a lower mortality risk compared with non-O blood groups (OR 0•660; P = 0•014) [3]. Zietz & Tatonetti mentioned the significance of this association in only Rh-positive blood types 4. But what is important to note, is that the association of blood type is not explainable by other risk factors e.g. obesity, diabetes mellitus and other comorbidities [4]. The linkage and effects of blood groups have been hypothesized using different facts: For one, blood groups are dictated by sugars, and coronaviruses in the cattle have surface proteins that bind to sugars. It might be of value to consider the extra sugar N-acetyl galactosamine, on the surface of blood group A cells [5], possibly suggesting more pathogen contact. This sugar is missing on blood group O cells [5]. The association of the spike (S) protein of SARS-CoV-2, a transmembranal protein, has been shown with ACE2 protein that acts as its cellular receptor [6]. As suggested in the past for SARS-CoV [7], the adhesion of Spike protein to the ACE2 receptor on the host cell surface may be inhibited by the presence of anti-A antibody. Although this may be true for blood group B and blood group O, it does not explain blood group AB, that even without anti-A antibody does not have a higher

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Objective: To assess burnout in medical educators and to identify factors associated with it. Methods: A sequential mixed methods research study was conducted over eight months from July 2018 until February 2019. Participants included medical educators, who are studying for or graduated with a postgraduate qualification in medical education. An online questionnaire was developed using Maslach Burnout Inventory to collect quantitative data. The findings were explored in-depth qualitatively. Descriptive and inferential statistics were calculated for the quantitative data using SPSS 20. For qualitative data, we performed thematic analysis. Results: Of total 160 medical educationists, 101 responded giving 63.1% response rate. Mean age was 41.4 years and majority 53.5% were females. Overall aggregate mean burnout level was 12.34 ± 7.36 whereas sub-domains of Maslach burnout inventory( MBI) like i) emotional exhaustion, ii) depersonalization and iii) personal accomplishment were found out to be 19.59, 10.42 and 11.21 respectively. Most respondents had moderate 71 (70.3%) emotional exhaustion and 8 (8.9%) had severe emotional exhaustion. Average level of depersonalization was suffered by 73 (72.3%) respondents and severe level was observed in 20 (19.8%) respondents. Personal accomplishment was found low in all 101 (100.0%) respondents. Selective in-depth interviews revealed that coping mechanisms like social gatherings, indoor and outdoor game facilities and outings and leisure time should be strategized for faculties. Conclusion: In this study medical educators were found to have quite high level of burnout. The early career medical educators feels emotionally exhausted, with low sense of personal accomplishment. doi: https://doi.org/10.12669/pjms.37.3.3078 How to cite this:Akram Z, Sethi A, Khan AM, Zaidi FZ. Assessment of burnout and associated factors among medical educators. Pak J Med Sci. 2021;37(3):---------. doi: https://doi.org/10.12669/pjms.37.3.3078 This is an Open Access article distributed under the terms of the Creative Commons Attribution License (http://creativecommons.org/licenses/by/3.0), which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited.

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Introduction: Secondary Central Nervous System Lymphoma (SCNSL) is the spread of a lymphoma to the CNS, the primary focus of which is situated elsewhere in the body. Most commonly, it is a non-Hodgkin lymphoma which either presents as a CNS involvement due to systemic relapse or progression, or as an isolated relapse in the CNS despite systemic remission. Traditionally, it has been treated by intrathecal or systemic chemotherapy and/or WBRT (Whole-brain radiation therapy) but recently, the use of high-dose chemotherapy (HDT) with autologous stem cell transplantation (ASCT) has shown encouraging results. We present a systematic review of literature displaying the treatment outcomes of HDT/ASCT in SCNSL. Methods: We performed a comprehensive literature search (following PRISMA guidelines) on July 08 2020 on PubMed, Cochrane Library and Clinicaltrials.Gov by using the relevant MeSH terms of high-dose chemotherapy, autologous stem cell transplantation, CNS lymphoma, efficacy and safety. Following screening by 2 reviewers, we selected 12 published studies (n=353) and included data from these studies in our systematic review. We manually extracted data summarized the results. Results: 232/353 patients eventually underwent sequential HDT+ASCT who were evaluable for treatment response out of which 190 patients had SCNSL (see table 1). Carmustine (BCNU) based HDT: BCNU based regimens have been the most extensively studied HDT among SCNSL patients (n=81). Korfel et al. in a phase 2 trial (2013, n=30) used HDT combination of BCNU, thiotepa and etoposide followed by ASCT in SCNSL patients. No patient was given whole brain radiation therapy (WBRT). The results yielded a PR of 8%, CR of 63% and 2-year OS of 63%. 1 toxicity related mortality (TRM) was noted and &gt;grade 4 adverse effects included infection (4%) and stomatitis (13%). Ferreri et al. (2015, n=38) in a phase 2 trial use HDT with BCNU plus thiotepa on 38 patients 20 of whom underwent subsequent ASCT. The results showed CR of 100%, event free survival (EFS) of 40% ±9% and OS of 41% ±8% at 5 years with four patients suffering TRM. Thiotepa, busulfan and cyclophosphamide (TBC) based HDT: The combination based on TBC has been a popular option for SCNSL patients (n=53). In a retrospective analysis by Welch et al. (2014, n=17), TBC combination followed by sequential ASCT was studied in both primary and SCNSL patients (primary malignancy being diffuse large B-cell lymphoma) and the collective results showed complete response (CR) of 100%, PFS of 93% (95% CI: 61-99%) and OS of 93% (95% CI: 61-99%) at 3 years. In addition to the excellent efficacy response, no TRM or grade 4 toxicities were documented. Chen et al. (2015, n=12) in a phase 2 trial used HDT with rituximab and TBC (R-TBC) combination followed by ASCT rescue in 12 SCNSL patients. At 2 years, the progression free survival (PFS) was 51% (95% CI: 18-77%) and overall survival (OS) was 83% (95% CI: 48-96%). Two patients developed neurotoxicity and one TRM was recorded. Methotrexate (MTX) based HDT: MTX based combinations have also been widely used as HDT preceding ASCT in SCNSL patients (n=51). Fischer et al. (2008, n=20) studied HDT of MTX plus ifosfamide (IFO) in a retrospective analysis which showed PR of 30%, CR of 60% and median OS of 8.7 months and two TRM (due to sepsis in neutropenia) in SCNSL patients. Lee et al. (2015, n=31) in a prospective cohort study evaluated HDT with MTX based multidrug combination with ASCT in SCNSL patients which yielded a PR of 41.6%, CR of 50% and OS of 9 months (95% CI: 5-12 months). Five patients had suffered TRM. Conclusion: The combination of HDT with ASCT has yielded promising treatment outcomes both in terms of favorable efficacy rates and reduced rates of toxicity in SCNSL patients proving to be a comparable alternative to traditionally used chemo-radiation. However, the data at present is limited to few phase 2 trials with some being displayed collectively with data of primary CNS lymphoma patients. There is an increased need to carry out randomized phase 3 trials exclusively on SCNSL patients to better predict the efficacy and safety profile of HDT/ASCT in these patients. Disclosures Anwer: Incyte, Seattle Genetics, Acetylon Pharmaceuticals, AbbVie Pharma, Astellas Pharma, Celegene, Millennium Pharmaceuticals.: Honoraria, Research Funding, Speakers Bureau.