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Omani (Dhofari) frankincense is world famous for its high quality and fragrance. The oleo-gum resin obtained from the tree of Omani species i.e., Boswellia sacra (local name: luban) is widely used by the natives. The aim of the study was to determine the presence of phytochemicals in chloroform and ethanol extracts of B. sacra resin and to evaluate the in vitro cytotoxic, antimicrobial- and antioxidant-activities. The ethanol and chloroform extracts of Hojari luban were obtained in good yield. The extracts were subjected to phytochemical screenings, quantification of total phenolics (TP) and evaluation of in vitro biological activities viz. antioxidant, antibacterial and cytotoxic potential. The bioactivities of four boswellic acids, the major constituents of the oleo-gum resin, were also predicted with the help of PASS and CLC-pred software. Both the extracts showed similar level of TP (14.67 mg/g and 14.79 mg/g in terms of gallic acid equivalent) but polar fraction was noted to be more active against E. coli. A moderate antioxidant activity was shown by the resin extracts however their cytotoxic activity was observed to be quite remarkable at 1000 μg/l which could be attributed to their high boswellic acid content. Results of in silico PASS studies showed boswellic acids to possess an array of useful biological activities including chemopreventive activity. Further, CLC-pred software revealed that only keto boswellic acid is expected to exert antineoplastic activity against pancreatic carcinoma cell lines, however all the four major boswellic acids are likely to be active against non-tumor embryonic lung fibroblast (MRC5). The study confirmed that frankincense is rich in bioactive metabolites which are of significant economic and therapeutic importance. Dhaka Univ. J. Pharm. Sci. 19(2): 105-110, 2020 (December)

Case Report: We present an extremely rare case of anterior rectal duplication cyst in a 36-year old female patient. The patient presented with deep perineal pain, constipation, and severe dyspareunia. Pelvic examination showed a mass in the rectovaginal space. The condition has been diagnosed by MRI. The cyst was completely excised through transvaginal approach due to its lower anterior location. The transvaginal approach was safe, easy and was followed by well-preserved anal functions. Post-operative histopathological examination confirmed the diagnosis of rectal duplication cyst. The patient was followed for one year and she reported complete disap-pearance of her pre-operative symptoms.Conclusions: Although anterior rectal duplication is an extremely rare condition, it should be put into consideration in managing patients with pararectal cysts. MRI is an efficient radiological investigation that accurately describes the cyst and its relation to surrounding structures. Transvaginal ap-proach is a safe and easy approach to excise these lesions, especially when they have a low anterior location.

Result: The study included 803 patients who had simple cholecystectomy. Three of these patients were found to have gallbladder carcinoma, two females and one male. Dense adhesions were encountered in all malignant cases necessitating conversion from laparoscopic to open cholecystectomy in one case. Macroscopic examination revealed a thickened gallbladder in all three patients; two patients had mucosal papillary lesions and one patient had polypoidal projection and mucosal ulcerations. These findings were confirmed by the pathologist. On microscopic examination, two patients had adenocarcinoma while one patient had neuroendocrine tumor.

Background Clinical scores were designed to improve the diagnostic accuracy (DA) of acute appendicitis. However, their results vary when applied in different populations. This study aimed to compare the validity of the Modified Alvarado Score (MAS) with the Raja Isteri Pengiran Anak Saleha (RIPASA) score for diagnosing acute appendicitis in adult Saudi population. Materials and methods This study followed a prospective study design. It was carried out in Aseer Central Hospital, Abha, Saudi Arabia, during the period from November 2014 to May 2015. The study included 60 (aged >13 years) patients who were admitted in the Emergency Department and were clinically diagnosed as having acute appendicitis. Both the MAS and the RIPASA score were applied. A cutoff value for positive MAS was more than or equal to 7, and it was of at least 7.5 for positive RIPASA score. Surgical team members were blinded to the results of both scores. Operative findings describing the appendix, postoperative complications, hospital stay, and final diagnosis by histopathology were recorded. Results The study included 60 patients. There were 17 (28.3%) male and 43 (71.7%) female patients, with a mean age of 23.3±9.7 years. Negative appendectomy rate was 13.3%. The mean duration of hospital stay was 2.39±1.67 days. The MAS showed poor sensitivity (59.6%), poor DA (63.3%), and good specificity (87.5%). Compared with the MAS, the RIPASA score showed better sensitivity (96.2%) and DA (85.0%) when applied to our patients. Conclusion Neither the RIPASA score nor the MAS seems ideal for the accurate diagnosis of acute appendicitis when applied to patients in the southern region of Saudi Arabia.

Many surgeons practice prophylactic drainage after cholecystectomy without reliable evidence. This study was conducted to answer the question whether to drain or not to drain after cholecystectomy for acute calculous cholecystitis. A retrospective review of all patients who had cholecystectomy for acute cholecystitis in Aseer Central Hospital, Abha, Saudi Arabia, was conducted from April 2010 to April 2012. Data were extracted from hospital case files. Preoperative data included clinical presentation, routine investigations and liver function tests. Operative data included excessive adhesions, bleeding, bile leak, and drain insertion. Complicated cases such as pericholecystic collections, mucocele and empyema were also reported. Patients who needed therapeutic drainage were excluded. Postoperative data included hospital stay, volume of drained fluid, time of drain removal, and drain site problems. The study included 103 patients allocated into two groups; group A (n = 38) for patients with operative drain insertion and group B (n = 65) for patients without drain insertion. The number of patients with preoperative diagnosis of acute non-complicated cholecystitis was significantly greater in group B (80%) than group A (36.8%) (P < 0.001). Operative time was significantly longer in group A. All patients who were converted from laparoscopic to open cholecystectomy were in group A. Multivariate analysis revealed that hospital stay was significantly (P < 0.001) longer in patients with preoperative complications. There was no added benefit for prophylactic drain insertion after cholecystectomy for acute calculous cholecystitis in non-complicated or in complicated cases.