In this issueCLINICAL GUIDELINESORIGINAL ARTICLESCASE REPORT
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# CLINICAL GUIDELINES {#article-title-2}

**The Saudi Critical Care Society extracorporeal life support chapter guidance on utilization of veno-venous extracorporeal membrane oxygenation in adults with acute respiratory distress syndrome and special considerations in the era of coronavirus disease 2019**

Mufi et al with Corporeal Life Support-Saudi Critical Care Society wanted to generate a document that can be used to simple guide, with a focus on safety, to provide extracorporeal membrane oxygenation service for patients with severe adult respiratory distress syndrome with a special focus on SARS-CoV-2.

![Figure1](http://smj.org.sa/https://smj.org.sa/content/smj/42/6/587/F1.medium.gif)

[Figure1](http://smj.org.sa/content/42/6/587/F1)

General demonstration of the standard components of an extracorporeal membrane oxygenation (ECMO) circuit.

***see page 589***

# ORIGINAL ARTICLES {#article-title-3}

**Vascular cell adhesion molecule-1 in rheumatoid arthritis patients.** *Relation to disease activity, oxidative stress, and systemic in ammation*

Salem et al evaluate the potential role of vascular cell adhesion molecule-1 (VCAM-1), an endothelial factor, in endothelial dysfunction in rheumatoid arthritis (RA) patients, and determine its relation to disease activity, oxidative stress, and in ammatory markers. Patients with RA showed significantly higher serum VCAM-1, malondialdehyde, erythrocyte sedimentation rate, C-reactive protein, triglycerides, total cholesterol, low-density lipoprotein, and atherogenic index levels than the control group. Finally, serum VCAM-1 increases in RA, and it correlates with disease activity, oxidative stress, and in ammatory markers.

![Figure2](http://smj.org.sa/https://smj.org.sa/content/smj/42/6/587/F2.medium.gif)

[Figure2](http://smj.org.sa/content/42/6/587/F2)

Scatter plot representing the correlation between Disease Activity Score-28 (DAS28) and serum level of vascular cell adhesion molecule-1 (VCAM-1). r=correlation coeficient. P<0.001 is highly significant.

***see page 620***

**Economic perspective of evaluating fertility treatment in obese and overweight infertile women**

Rafique et al evaluate 826 subfertility patients who had in-vitro fertilization/intracytoplasmic sperm injection (IVF/ICSI) in 2017 to 2018 direct cost of IVF/ICSI cycle and reproductive outcomes among infertile women with different body mass index (BMI). A total of 338 patients (40.9%) were overweight, and 300 (36.3%) patients were obese. A bottom-up methodology was used to measure the resource utilization. There was no statistical significant difference for live birth rate (LBR) among the BMI groups, with the occurrence of LBR in 23 women with normal BMI (13.1%), in 48 (14.2%) women who were overweight, in 48 (16%) in women who were obese (*p*=0.7). The results suggest that costs of IVF/IVF- ICSI is not signidficantly affected in women who are overweight or obese.

***see page 666***

# CASE REPORT {#article-title-4}

**The role of malleostapedotomy in intra-operative incus injury**. *A review of 2 cases*

Alabdulqader & Hajr present a 26-year-old Saudi Arabian man underwent right tympanoplasty in a peripheral hospital in 2013 and a 60-year-old Saudi man with bilateral hearing loss and diagnosed as case of bilateral otosclerosis underwent left stapedotomy in April 2019. As the procedure was surgically difficult and time consuming, many otologists prefer not to do it. Nevertheless, we believe that all surgeons dealing with stapes surgery should be familiar and gain confidence in performing malleostapedotomy considering that intraoperative incus dislocation is a complication that can happen even with great caution.

***see page 688***

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