Aim of the work: To detect the presence of Anti-Cyclic-Citrullinated Peptide Antibodies (anti CCP Ab) and Anti-Modified Citrullinated Vimentin Antibodies (anti MCV Ab) in Systemic Lupus Erythematosus (SLE) and Systemic Sclerosis (SSc) patients and their correlation to radiological findings and disease activity.

Methods: This study was included 70 SLE patients and 30 SSc patients diagnosed according to ACR classification criteria. After informed consent, all patients were subjected to detailed history taking, full clinical examination including rheumatological examination, laboratory investigations: included CBC, ESR, CRP with titer, urine analysis, renal and liver function, serum uric acid, ANA, Anti dsDNA antibodies by Indirect Immunofluorescence Method (IIF), Anti Scl 70 antibody, Anti CCP and Anti MCV antibodies done by ELISA. X- Ray and U/S on both hands and knees and disease activity score using SLEDAI score for SLE patients and Medsgar score for SSc patients.

Results: In this study, anti CCP Ab were found in 8 (11.4%) of SLE patients and 4 (13.3%) SSc patients, while anti MCV Ab were found in 14 (20%) SLE patients and 8 (26.7%) of SSc patients. There is association between presence of anti CCP Ab and anti MCV Ab and a clinically evident arthritis in both SLE and SSc. Strong relationship between high CRP level and a severe arthritis and joint erosions was noticed in SLE patients. A significant radiological evident erosive arthritis in the form of synovial hypertrophy and bony erosions were found using ultrasonography and plain X-ray with seropositive anti CCP and anti MCV Ab in both SLE and SSc patients. In our study, cut off value of anti CCP which was >12, with sensitivity of 70.42% and specificity of 60%and best cut off value of Anti MCV which was >11, with sensitivity of 98.46% and specificity of 30% in SLE and SSc.

Conclusion: There is a significant association between presence of anti CCP Ab and anti MCV Ab and the presence of clinically and radiologicaly evident erosive arthritis assessed by x-ray and U/S in both SLE and SSc patients.

Background: Lipomas are the most common soft-tissue tumors and may appear at any site. The usual presentation is as a solitary, slow-growing and painless subcutaneous tumor. Deep-seated, intra- and extramuscular lipomas are less common and are larger than subcutaneous lipomas. Our objectives were to study the clinical and radiological characteristics and treatment of Tunisian Deep-seated lipomas of the upper extremity patients and review the literature.

Methods: A retrospective study of all patients with deep-seated lipomas of the upper extremity, treated surgically between 1990 and 2011, was carried out. Clinical and radiological characteristics, treatment, and evolution profile of these patients were also evaluated. Patients were followed for 5 years.

Results: Twenty three patients were identified. There were 17 women and 6 men. The mean age of patients was 45 years (range 25 to 80 years). Eight of these lipomas were in the arm, eight in the shoulder, three in the hand, three in the forearm and one in the elbow. Standard radiography, ultrasonography, Computer Tomography (CT) or Magnetic Resonance Imaging (MRI) suggested the lipomatous nature and benign characteristics of these deep lipomas. Lipoma marginal excision was performed and histopathological examination demonstrated features of benignity. There were two intramuscular lipomas, two angiolipomas and nineteen lipomas. There was no recurrence after the surgery.

Conclusion: All deep-seated lipomas are found to have infiltrative property, but variations may arise concerning their growing patterns and direction. It may wrap around nerves thus a careful dissection is needed in order to avoid severe damage.

Introduction: Nonunion rates of distal femur fractures range between 10 and 20%. Previous studies have tried to identify parameters that predict impaired bone healing. These factors include local changes after major trauma such as open fractures and highly comminuted fractures. In addition to these local factors, increasing evidence suggests that the systemic inflammatory response induced by major trauma also impairs bone regeneration. We retrospectively studied patients with distal femur fractures and aimed to identify parameters that predict impaired fracture healing.

Patients and methods: All patients with distal femur fractures treated at a level one trauma center and two large teaching hospitals with locked plating techniques between January 2007 and December 2014 were included. Using multivariable logistic regression, we determined which parameters were independent predictors of impaired fracture healing.

Results: A total of 58 fractures in 56 patients were analysed. 26 fractures were caused by high-energy trauma (45%) and 26 patients developed impaired healing (45%). Impaired fracture healing occurred more frequently after High Energy Trauma (p<0.001), open fractures (p<0.001), comminuted fractures (p=0.001) and in younger patients (p<0.001). High Energy Trauma remained an independent predictor of impaired fracture healing when open fractures and comminution were included in the multivariable logistic regression.

Conclusion: High energy trauma, open fractures and comminution were all identified as independent predictors of impaired fracture healing. This indicates that high energy trauma, regardless of the fracture type that results, may negatively affect fracture healing.

Background: Methotrexate (MTX) + Medical Ozone increase MTX clinical efficacy in Rheumatoid Arthritis (RA) patients. Aim: The purpose of this study was to investigate whether medical ozone could decrease the risk of γ -Glutamyl Trasnsferase (GGT), Alkaline Phosphatase (ALP) abnormalities and oxidative stress in RA patients.

Methods: A prospective study with 100 patients was performed, who were divided into two groups: one (n = 50) treated with MTX, Folic acid and Ibuprophen (MTX Group) and the second group (n = 50) receiving the same as the MTX Group + medical ozone by rectal insufflation. The diagnosis of RA patients was performed using AntiCyclic Citrullinated Peptides levels, DAS-28 and HAQ-DI. The risk of liver marker abnormalities and the oxidative stress were evaluated by means of biochemical methods and statistical tests.

Results: MTX + Ozone reestablished γ-Glutamyl Trasnsferase (GGT), reduced Alkaline Phosphatase (ALP), enhanced the antioxidants endogenous and decreased oxidative damage to biomolecules with regard to MTX monotherapy. Patients treated with MTX + medical ozone decreased the risk of GGT and ALP abnormalities by a factor of 4. An inverse correlation between GGT and reduced glutathione was found.

Conclusions: MTX + Ozone regulated and decreased the risk of GGT and ALP abnormalities. The modulation of GGT by ozone and the reduction of oxidative stress may play an important role against liver damage induced by MTX.