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Background Globally many studies have reported on violence faced by healthcare workers. However, there is still a lack of homogeneous data to give us a concrete understanding of the present scenario on a global scale. Conducting a global survey required a robust team organization structure, unique dissemination strategies accounting for the regional limitations, and continual networking to maintain and propagate the pool of survey collaborators and responders. This study aims to describe the strategies that helped carry out a global survey- based study, the lessons learned, and recommendations for future studies.   Methods This cross-sectional survey-based study was based on methodology of the “Hub and Spoke” model with the core team and sub-groups about different regions and managing country leads. The study was conducted across eight weeks from 6th June 2022 to 8th August 2022. The key steps included team organization, strategy formulation for survey dissemination and data collection, launching the project on social media, and conducting a post-survey amongst the collaborators. The Core Team convened weekly via video conference platforms to discuss the modus operandi, including the responsibilities of team members in communicating with HCWs from each country; strategies for data extraction and analysis. A standard message was created for the survey in English, which was spread via text, audio and video messages; the message was tailored according to the target region and population. The language barrier was managed by creating an audio translation or shifting to “an interviewer-administered” questionnaire. Call for leads and collaborators was organized through social media platforms and incentivized by proposing collaborative authorship.   Results A core team of 11 members from 7 countries was assembled, which expanded to 40 country leads from around 110 countries. We also amassed more than 75 regional collaborators who worked to provide feedback and spread the message. The “Violence Study of Healthcare Workers and Systems” (VISHWAS) amassed 5500 responses across the world. A weekly alternating trend in the number of survey responses was observed for eight weeks. Guiding principles garnered through this collaborative project include focusing on 1. Effective team organization, 2. Ensuring external validation of survey tool, 3. Personalized communication, 4. Global networking, 5. Timely communication for maintaining momentum, and 6. Addressing regional limitations. The post-survey analysis showed that WhatsApp messaging was the most common modality used for survey dissemination, followed by in-person meetings and text messaging. The successful techniques were noted to be 1. Direct communication with respondents, 2. Regular progress updates, 3. Responsiveness for regional and country lead’s needs  4. Timely troubleshooting. The most common barriers for the respondents were limitations in language proficiency, technical fallouts, lack of compliance with, and difficulty understanding the questionnaire.   Conclusion In this global survey-based study of more than 5500 responses from over 110 countries, valuable lessons in team management, survey dissemination, and addressing barriers to collaborative research. We thereby recommend incorporating the guiding principles from this study to design future surveys on a global scale.

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The coronavirus disease 2019 continues to be a devastating disease for the elderly population, especially in long-term care facilities, and it presents with varying clinical presentations. We have ample evidence that COVID-19 can predispose to deep vein thrombosis (DVT) and pulmonary embolism (PE) during an active infection. Still, very few cases of DVT have been reported after recovery from COVID-19.The imbalance of the coagulation cascade and the increased release of certain coagulation factors play an essential role in promoting hypercoagulability and vascular endothelial dysfunction. It leads to a rise in the level of fibrin degradation products, D-dimers, which can remain elevated for up to several weeks, even after recovery. It has been suggested that the risk of DVT occurring after recovering from COVID-19 remains high for up to three months.We report a case of a 77-year-old long-term care female resident at a nursing facility, ambulatory at baseline, who was noted to be COVID-19 positive upon routine facility-wide testing per department of health guidelines. She was asymptomatic during her 10-day quarantine period. D-dimer levels during routine labs were high (initial D-dimer level of 1.87 mg/L FEU {normal value: 0.19-0.52 mg/L FEU}), but the patient had no clinical signs and symptoms of DVT. Ultrasound of the bilateral legs was not performed due to low clinical suspicion. The patient received an enoxaparin DVT prophylaxis dose during the quarantine period. Follow-up D-dimer levels were done at frequent intervals after recovery, but D-dimer levels continued to remain elevated up till six weeks after her 10-day quarantine period ended. Based on previous experience with other long-term care residents who suffered from COVID-19, bilateral lower extremity ultrasound was performed, which showed bilateral DVT. Elevated D-dimer levels are a predictor of hypercoagulation complications in COVID-19. Patients with persistently elevated D-dimer levels after recovery from COVID-19 should be screened for thromboembolic complications, even if they are asymptomatic. DVT can occur up to three months post-recovery from COVID-19 infection.

Background and Objective: The association of non-alcoholic fatty liver disease (NAFLD) and metabolic-associated fatty liver disease (MAFLD) with intensive care unit (ICU) admissions and the need for mechanical ventilation and disease severity in COVID-19 patients. Material and Methods: A systematic literature review was conducted on the databases: Cochrane, Embase, PubMed, ScienceDirect, and the Web of Science from January 2019 to June 2022. Studies evaluating MAFLD using laboratory methods, non-invasive imaging, or liver biopsy were included. The study protocol was registered in PROSPERO (ID CRD42022313259), and PRISMA guidelines were followed. The NIH quality assessment tool was used for quality assessment. RevMan version 5.3 software was used for pooled analysis. A sensitivity analysis was performed to assess the result’s stability. Results: A total of 37,974 patients from 17 studies were assessed for the association between MAFLD and ICU admission. A total of 3396 COVID-19 patients required ICU admission: 1236 (20.41%) in the MAFLD group and 2160 (6.77%) in the non-MAFLD group. The odds ratio was 1.86 for ICU admission, p = 0.007, and a (95% CI) of [1.18–2.91]. A total of 37,166 patients from 13 studies were included in the need for invasive mechanical ventilation analysis. A total of 1676 patients required mechanical ventilation: 805 in the MAFLD group (14.20% of all MAFLD patients) and 871 patients in the non-MAFLD group (2.76% of all non-MAFLD patients). The odds ratio was 2.05, p = 0.02, and a (95% CI) of [1.12–3.74]. A total of 5286 patients from 14 studies were included in the COVID-19 disease severity analysis. Severe COVID-19 was seen in 1623 patients, with 33.17% (901/2716) of MAFLD patients and 28.09% (722/2570) of non-MAFLD patients having severe disease. The odds ratio was 1.59 for disease severity, p = 0.010, and a (95% CI) of [1.12–2.26]. Conclusions: Our meta-analysis suggests that there are significantly increased odds of ICU admissions, a need for invasive mechanical ventilation, and disease severity in MAFLD patients who acquire COVID-19.

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