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Objective To estimate the cost-effectiveness of craniotomy, compared with decompressive craniectomy (DC) in UK patients undergoing evacuation of acute subdural haematoma (ASDH).Design Economic evaluation undertaken using health resource use and outcome data from the 12-month multicentre, pragmatic, parallel-group, randomised, Randomised Evaluation of Surgery with Craniectomy for Patients Undergoing Evacuation-ASDH trial.Setting UK secondary care.Participants 248 UK patients undergoing surgery for traumatic ASDH were randomised to craniotomy (N=126) or DC (N=122).Interventions Surgical evacuation via craniotomy (bone flap replaced) or DC (bone flap left out with a view to replace later: cranioplasty surgery).Main outcome measures In the base-case analysis, costs were estimated from a National Health Service and Personal Social Services perspective. Outcomes were assessed via the quality-adjusted life-years (QALY) derived from the EuroQoL 5-Dimension 5-Level questionnaire (cost-utility analysis) and the Extended Glasgow Outcome Scale (GOSE) (cost-effectiveness analysis). Multiple imputation and regression analyses were conducted to estimate the mean incremental cost and effect of craniotomy compared with DC. The most cost-effective option was selected, irrespective of the level of statistical significance as is argued by economists.Results In the cost-utility analysis, the mean incremental cost of craniotomy compared with DC was estimated to be −£5520 (95% CI −£18 060 to £7020) with a mean QALY gain of 0.093 (95% CI 0.029 to 0.156). In the cost-effectiveness analysis, the mean incremental cost was estimated to be −£4536 (95% CI −£17 374 to £8301) with an OR of 1.682 (95% CI 0.995 to 2.842) for a favourable outcome on the GOSE.Conclusions In a UK population with traumatic ASDH, craniotomy was estimated to be cost-effective compared with DC: craniotomy was estimated to have a lower mean cost, higher mean QALY gain and higher probability of a more favourable outcome on the GOSE (though not all estimated differences between the two approaches were statistically significant).Ethics Ethical approval for the trial was obtained from the North West—Haydock Research Ethics Committee in the UK on 17 July 2014 (14/NW/1076).Trial registration number ISRCTN87370545.

Abstract Necrotrophic pathogen Cochliobolus miyabeanus (C. miyabeanus) causes rice brown leaf spot disease and drastically affects the yield and quality of rice grains. However, the molecular mechanism of rice-C. miyabeanus remains poorly understood due to the limited research conducted on this pathosystem. To elucidate the molecular mechanism of rice-C. miyabeanus, a transcriptome analysis was conducted from in vitro and in planta grown C. miyabeanus. This analysis led to the identification of a total of 24,060 genes of which 426 in vitro and 57 in planta expressed genes were predicted to encode for secretory proteins. As these 57 genes were specifically expressed in planta and were predicted to be secretory in nature, these were consider as putative effectors, highlighting their possible roles in the fungal pathogenicity. Notably, among these putative effectors, CmXyn1 which encodes a glycosyl hydrolase 11 displayed the highest expression level under in planta conditions and was thus selected for further functional characterization. Interestingly, the extracellular expression of CmXyn1 transiently induced cell death in Nicotiana benthamiana leaves, while intracellular expression was comparatively lesser effective. In addition, transcriptome analysis on rice leaves during C. miyabeanus infection and comparing it to the rice leaf transcriptome data obtained during hemibiotrophic pathogen Magnaporthe oryzae infection led to the discovery of 18 receptors/receptor-like kinases that were commonly expressed in response to both pathogens, indicating their key roles in rice defense response. Taken together, our findings provide new insights into rice-C. miyabeanus interaction as well as the unique and common defense responses of rice against hemibiotroph and necrotroph model systems.

The purification of ethylene is an industrially relevant process. Here, the authors report the one-step separation of ethylene from quaternary gas mixtures of hydrocarbons and CO2 using a single metal–organic framework-based physisorbent.

Mass-spectrometry based immunopeptidomics has provided unprecedented insights into antigen presentation, not only charting an enormous ligandome of self-antigens, but also cancer neoantigens and peptide antigens harbouring post-translational modifications. Here we concentrate on the latter, focusing on the small subset of HLA Class I peptides (less than 1%) that has been observed to be post-translationally modified (PTM) by a O-linked N-acetylglucosamine (GlcNAc). Just like neoantigens these modified antigens may have specific immunomodulatory functions. Here we compiled from literature, and a new dataset originating from the JY B cell lymphoblastoid cell line, a concise albeit comprehensive list of O-GlcNAcylated HLA class I peptides. This cumulative list of O-GlcNAcylated HLA peptides were derived from normal and cancerous origin, as well as tissue specimen. Remarkably, the overlap in detected O-GlcNAcylated HLA peptides as well as their source proteins is strikingly high. Most of the O-GlcNAcylated HLA peptides originate from nuclear proteins, notably transcription factors. From this list, we extract that O-GlcNAcylated HLA Class I peptides are preferentially presented by the HLA-B*07:02 allele. This allele loads peptides with a Proline residue anchor at position 2, and features a binding groove that can accommodate well the recently proposed consensus sequence for O-GlcNAcylation, P(V/A/T/S)g(S/T), essentially explaining why HLA-B*07:02 is a favoured binding allele. The observations drawn from the compiled list, may assist in the prediction of novel O-GlcNAcylated HLA antigens, which will be best presented by patients harbouring HLA-B*07:02 or related alleles that use Proline as anchoring residue.

Despite the role of γ-aminobutyric acid (GABA) in plant tolerance to chilling stress having been widely discussed in the seedling stage, very little information is clear regarding its implication in chilling tolerance during the reproductive stage of the plant. Here, we investigated the influence of GABA (1 and 2mM) as a foliar application on tomato plants (Solanum lycopersicum L. cv. Super Marmande) subjected to chilling stress (5°C for 6h/day) for 5 successive days during the flowering stage. The results indicated that applied GABA differentially influenced leaf pigment composition by decreasing the chlorophyll a/b ratio and increasing the anthocyanin relative to total chlorophyll. However, carotenoids were not affected in both GABA-treated and non-treated stressed plants. Root tissues significantly exhibited an increase in thermo-tolerance in GABA-treated plants. Furthermore, applied GABA substantially alleviated the chilling-induced oxidative damage by protecting cell membrane integrity and reducing malondialdehyde (MDA) and H2O2. This positive effect of GABA was associated with enhancing the activity of phenylalanine ammonia-lyase (PAL), catalase (CAT), superoxide dismutase (SOD), and ascorbate peroxidase (APX). Conversely, a downregulation of peroxidase (POX) and polyphenol oxidase (PPO) was observed under chilling stress which indicates its relevance in phenol metabolism. Interesting correlations were obtained between GABA-induced upregulation of sugar metabolism coinciding with altering secondary metabolism, activities of antioxidant enzymes, and maintaining the integrity of plastids’ ultrastructure Eventually, applied GABA especially at 2mM improved the fruit yield and could be recommended to mitigate the damage of chilling stress in tomato plants.

Sleep-wakefulness is disrupted in most neurological and psychiatric disorders. Although clinical data implicate orexin (hypocretin), a crucial sleep/wake regulatory neuropeptide, in such disorders, limited sample volumes effectively prevent quantification of cerebrospinal fluid (CSF) levels of orexin A in mouse models of brain disorders. Current enzyme- and radio-immunoassays for orexin A generally require 50–100 µL CSF, whereas typical CSF sample volumes from mice are ~5–10 µL/mouse. We therefore aimed to develop and validate a liquid chromatography (LC) targeted mass spectrometry (MS) method for the absolute quantification of orexin A in the CSF of individual mice. LC coupled to tandem MS (LC-MS/MS) and a triple quadrupole (QQQ) mass spectrometer were used to develop a LC electrospray ionization multiple-reaction monitoring (LC-ESI-MRM) method. CSF orexin A levels of C57BL/6JARC mice were quantified using this method at the predicted peak and trough of diurnal orexin A release and following sleep deprivation. The LC-ESI-MRM assay was robust and sensitive, with an intra-assay variation

The mechanism by which folic acid (FA) or its derivatives (folates) mediates plant tolerance to sodic-alkaline stress has not been clarified in previous literature. To apply sodic-alkaline stress, maize seedlings were irrigated with 50 mM of a combined solution (1:1) of sodic-alkaline salts (NaHCO3 and Na2CO3; pH 9.7). Maize seedlings under stressed and non-stressed conditions were sprayed with folic acid (FA) at 0 (distilled water as control), 0.05, 0.1, and 0.2 mM. Under sodic-alkaline stress, FA applied at 0.2 mM significantly improved shoot fresh weight (95%), chlorophyll (Chl a (41%), Chl b (57%), and total Chl (42%)), and carotenoids (27%) compared to the untreated plants, while root fresh weight was not affected compared to the untreated plants. This improvement was associated with a significant enhancement in the cell-membrane stability index (CMSI), relative water content (RWC), free amino acids (FAA), proline, soluble sugars, K, and Ca. In contrast, Na, Na/K ratio, H2O2, malondialdehyde (MDA), and methylglycoxal (MG) were significantly decreased. Moreover, seedlings treated with FA demonstrated significantly higher activities of antioxidant enzymes including superoxide dismutase (SOD), peroxidase (POX), catalase (CAT), and ascorbate peroxidase (APX) compared to the untreated plants. The molecular studies using RT-qPCR demonstrated that FA treatments, specifically at 0.2 mM, enhanced the K+/Na+ selectivity and the performance of photosynthesis under alkaline-stress conditions. These responses were observed through up-regulation of the expression of the high-affinity potassium-transporter protein (ZmHKT1), the major core protein of photosystem II (D2-Protein), and the activity of the first enzyme of carbon fixation cycle in C4 plants (PEP-case) by 74, 248, and 225% over the untreated plants, respectively. Conversely, there was a significant down-regulation in the expression ZmSOS1 and ZmNHX1 by 48.2 and 27.8%, respectively, compared to the untreated plants.

At Leeds General Infirmary, a busy tertiary centre for neurosurgery, there has been little visibility of the step-down status of the patients from intensive care to high dependency or from the latter to a ward bed. The only record of the current situation was limited to the paper notes of the bed managers. Furthermore, accuracy of electronic systems used for staffing levels and bed state were underused. There were gaps in information and furthermore information within the system was unreliable (together defined as ‘defects’). These defects mandated bed managers’ physical presence on each ward to obtain reliable data. This led to unwarranted critical care stays and resultant high rates (up to 40%) of elective operation cancellations requiring a critical care bed.The Leeds Improvement Method using principles of the Toyota Production System aimed to improve patient flow through critical care and to assess the impact on elective case activity. Problems were identified and changes were implemented over a 1-week period. The changes included measures to reduce time taken for collation of critical bed-state information and improving patient and staffing data quality collected in the electronic patient management system (EPMS) and electronic staffing record (ESR). Impact was monitored for 30 days pre-implementation and post-implementation.Following intervention, the time taken by the bed manager to gather live bed-state information decreased from 50 to 9 min; the EPMS storing correct bed-state data was improved from 71% to 0% defect; the ESR was improved from 100% to 4% defects; critical care patient step-downs occurring at night (after 20:00) improved from 80% to 20%; and the number of cancelled elective cases over a 30-day period reduced from nine to one.Implementing these organisational efficiencies can significantly improve critical care patient flow and elective case throughput.

Mild agate mortar activation followed by sintering of precursors, in resemblance to modified solid state process, was studied for synthesis of the aurivillius bismuth titanate. Hand on mill activation was carried out for eight hours followed by annealing treatment at 1000°C for 12 hours in presence of air atmosphere to obtain the proper phase. Scherrer’s formula was utilized to estimate crystallite size along with planes of orientation. Crystallite size was about 65nm while prominent peaks of orientations were (-117), (006), (111), (200) and others. FESEM and TEM studies were carried to obtain the morphology and estimated grain size of the synthesized aurivillius compound. Morphological features execute the material system to be nanocrystalline in nature as estimated from grain size measurement in correspondence with XRD crystallite size estimation. FTIR analysis confirms M-O coordinations of synthesized modified perovskite (aurivillius) sample. Optical property was evaluated from UV-VIS analysis with prominent absorption spectra in the visible region. Tauc plot was used to estimate the band gap to be about 2.86eV & 2eV for both direct and indirect transitions.

Abstract C2H2/CO2 separation is an industrially important process that remains challenging because of the similar physicochemical properties of C2H2 and CO2. We herein report that the new square lattice (sql) coordination network [Cu(bipy‐xylene)2(NO3)2]n, sql‐16‐Cu‐NO3, 16 = bipy‐xylene = 4,4′‐(2,5‐dimethyl‐1,4‐phenylene)dipyridine, exists in at least three forms, as‐synthesised (α), activated (α′) and hydrated (β). The activated phase, sql‐16‐Cu‐NO3‐α′, is an ultramicroporous material that exhibits high selectivity towards C2H2 over CO2 as revealed by dynamic gas breakthrough experiments (1:1, C2H2/CO2) that afforded 99.87% pure CO2 in the effluent stream. The separation selectivity at 298 K and 1 bar, 78, is the third best value yet reported for C2H2 selective physisorbents whereas the mid‐loading performance sets a new benchmark. The performance of sql‐16‐Cu‐NO3‐α′ is attributed to a new type of C2H2 binding site in which CH···ONO2 interactions enable moderately strong sorbent‐sorbate binding (Qst (C2H2) = 38.6 kJ/mol) at low loading. Conversely, weak CO2 binding (Qst (CO2) = 25.6 kJ/mol) at low loading means that (ΔQst)AC [Qst (C2H2)–Qst (CO2)] is 13 kJ/mol at low coverage and 11.4 kJ/mol at mid‐loading. Analysis of in situ powder X‐ray diffraction and modelling experiments provide insight into the sorption properties and high C2H2/CO2 separation performance of sql‐16‐Cu‐NO3‐α′.

Cysteine (Cys) and α-lipoic acid (ALA) are naturally occurring antioxidants (sulfur-containing compounds) that can protect plants against a wide spectrum of environmental stresses. However, up to now, there are no conclusive data on their integrative roles in mitigation of drought stress in wheat plants. Here, we studied the influence of ALA at 0.02 mM (grain dipping pre-cultivation treatment) and Cys (25 and 50 ppm as a foliar application) under well watered and deficit irrigation (100% and 70% of recommended dose). The results showed that deficit irrigation markedly caused obvious cellular oxidative damage as indicated by elevating the malondialdehyde (MDA) and hydrogen peroxide content (H2O2). Moreover, water stressed plants exhibited multiple changes in physiological metabolism, which affected the quantitative and qualitative variables of grain yield. The enzymatic antioxidants, including superoxide dismutase (SOD), ascorbate peroxidase (APX), catalase (CAT) and peroxidase (POX) were improved by Cys application. SOD and APX had the same response when treated with ALA, but CAT and POX did not. Moreover, both studied molecules stimulated chlorophyll (Chl) and osmolytes’ biosynthesis. In contrast, the Chl a/b ratio was decreased, while flavonoids were not affected by either of the examined molecules. Interestingly, all above-mentioned changes were associated with an improvement in the scavenging capacity of reactive oxygen species (ROS), leaf relative water content (RWC), grain number, total grain yield, weight of 1000 kernels, gluten index, falling number, and alveographic parameters (P, W, and P/L values). Furthermore, heatmap plot analysis revealed several significant correlations between different studied parameters, which may explore the importance of applied Cys and ALA as effective compounds in wheat cultivation under water deficit conditions.

Potassium (K+) is one of the vital macronutrients required by plants for proper growth and blossoming harvest. In addition, K+ also plays a decisive role in promoting tolerance to various stresses. Under stressful conditions, plants deploy their defense system through various signaling molecules, including hydrogen sulfide (H2S). The present investigation was carried out to unravel the role of K+ and H2S in plants under NaCl stress. The results of the study show that NaCl stress caused a reduction in K+ and an increase in Na+ content in the tomato seedling roots which coincided with a lower H+-ATPase activity and K+/Na+ ratio. However, application of 5 mM K+, in association with endogenous H2S, positively regulated the Na+/H+ antiport system that accelerated K+ influx and Na+ efflux, resulting in the maintenance of a higher K+/Na+ ratio. The role of K+ and H2S in the regulation of the Na+/H+ antiport system was validated by applying sodium orthovanadate (plasma membrane H+-ATPase inhibitor), tetraethylammonium chloride (K+ channel blocker), amiloride (Na+/H+ antiporter inhibitor), and hypotaurine (HT, H2S scavenger). Application of 5 mM K+ positively regulated the ascorbate–glutathione cycle and activity of antioxidant enzymes that resulted in a reduction in reactive oxygen species generation and associated damage. Under NaCl stress, K+ also activated carbohydrate metabolism and proline accumulation that caused improvement in osmotic tolerance and enhanced the hydration level of the stressed seedlings. However, inclusion of the H2S scavenger HT reversed the effect of K+, suggesting H2S-dependent functioning of K+ under NaCl stress. Therefore, the present findings report that K+, in association with H2S, alleviates NaCl-induced impairments by regulating the Na+/H+ antiport system, carbohydrate metabolism, and antioxidative defense system.

The microtubule binding protein EB1 specifically targets the growing ends of microtubules in cells, where EB1 facilitates the interactions of cellular proteins with microtubule plus-ends. Microtubule end targeting of EB1 has been attributed to high-affinity binding of EB1 to GTP-tubulin that is present at growing microtubule ends. However, our 3D single-molecule diffusion simulations predicted a ~ 6000% increase in EB1 arrivals to open, tapered microtubule tip structures relative to closed lattice conformations. Using quantitative fluorescence, single-molecule, and electron microscopy experiments, we found that the binding of EB1 onto opened, structurally disrupted microtubules was dramatically increased relative to closed, intact microtubules, regardless of hydrolysis state. Correspondingly, in cells, the blunting of growing microtubule plus-ends by Vinblastine was correlated with reduced EB1 targeting. Together, our results suggest that microtubule structural recognition, based on a fundamental diffusion-limited binding model, facilitates the tip tracking of EB1 at growing microtubule ends.

Metal-organic frameworks, popularly known as MOFs, have come of age—thanks to custom-built design principles enabling them to serve a myriad of task-specific applications. In an era where >6000 new MOFs are annually published, driven by academic research, a new generation of MOFs that can find use in niche markets is on the rise. One of the foremost challenges that plague the translation of MOFs into materials suited for commercialization is their water-influenced degradation, largely accountable to hydrolytic instability and the ubiquity of water. Hydrophobic MOFs offer one of the most promising solutions which can enable these porous materials to leverage their functionalization guided properties even under extreme humid conditions, a criterion that application-ready materials should necessarily serve. In this contribution, our discussion focuses on the state-of-the-art hydrophobic MOFs and MOF-derived composites. Outlining a brief overview of the structure-property correlation aspects in each of these promising hydrophobic MOFs with little or no influence exhibited to water and/or humidity, a future outlook is put forward to enable potentially better design strategies leading to futuristic MOFs tolerant to water/moisture. Concise premise of this review allows us to limit our discussion to the design principles in action behind the most hydrophobic MOFs/derived composites reported thus far and to discuss their prime applications viz., oil/water separation inclusive of self-cleaning, hydrocarbon separation, and tackling marine oil spillage. When synergized, such improved porous material design approaches lean toward a greener environment of tomorrow.

The present work reveals the beneficial role of sodium nitroprusside (SNP; NO donor concentration: 50 and 100 µM) in mitigation of water stress accompanied by a reduction in viral disease incidence in tomato plants subjected to deficit irrigation. The plants were grown under two irrigation regimes: well-watered (WW; irrigated after the depletion of 55–60% of available soil water) and water deficit (WD; irrigated after the depletion of 85–90% of available soil water) in two seasons of 2018 and 2019. The results indicated that under water stress conditions, plant growth, chlorophyll, relative water content (RWC), and fruit yield were decreased. Conversely, water stress significantly increased the MDA, proline, soluble sugars, and antioxidant enzymes’ activities. Moreover, it was obvious a negligible increase in the fruit content from NO2 and NO3. Water-deficit stress, however, had a positive impact on reducing the percentage of viral disease (TMV and TYLCV) incidence on tomato plants. Similarly, SNP application in the form of foliar spray significantly reduced the disease incidence, the severity, and the relative concentrations of TMV and TYLCV in tomato plants raised under both WW and WD conditions. The treatment of SNP at 100 µM achieved better results and could be recommended to induce tomato plant tolerance to water stress. Thus, the present work highlights the role of NO (SNP) in the alleviation of water stress in tomato plants and subsequent reduction in viral disease incidence during deficit irrigation.

Cobalt (Co) doped barium stannate, i.e. BaSn1−xCoxO3 with x = 0.05, 0.10 and 0.15 were prepared by mechanical mixing in agate mortar followed by sintering at 1350 °C for 2 hours. X-ray diffraction analysis (XRD) of the sample confirmed the cubic perovskite structure, crystallite size by Scherrer’s formula 50 nm, 49 nm respectively and planes of orientation (110), (111), (200), (211), (220) along the major peaks. Absorption spectra obtained due to symmetric and asymmetric stretching of M–O coordinated bond formations were determined by Fourier Transform Infrared Spectroscopy (FTIR). Band gap analysis of the sintered samples evaluated using Tauc relation was obtained from UV-VIS spectral analysis while luminescence by PL spectra. Morphological analyses were carried out by SEM while EDX was done to know the presence of required elements in the samples. Particle sizes of the samples were in the range of 50–100 nm obtained by HRTEM analysis. SAED pattern was also obtained for synthesized material indicating polycrystalline nature. Higher Co doping on barium stannate leads to decrease in dielectric constant due to possible lower ionic polarization at B site of perovskite.

Multiferroic bismuth ferrite (BFO) and Ni-doped bismuth ferrites, with perovskite structure, were synthesized by chemical route at the temperatures ranging from 500 to 600 °C in controlled atmosphere. The structural phase analysis of materials was identified by XRD and crystallite size was calculated from the half width measurement of the well defined major XRD diffraction peak. Average crystallite size was calculated by applying Scherrer’s formula and found to have values in the range from 14 to 35 nm. FESEM was used to evaluate the morphology and structural formation of nanocrystallite grains, while EDX confirmed elemental composition including the presence of dopant in the matrix. Dielectric properties and effect of electric field on polarization behaviour were studied for both undoped and Ni-doped BFO. Doping shows a clear change in ferroelectric behaviour. Antiferromagnetic nature of bulk bismuth ferrite transforms to superparamagnetic strong ferroelectric nature for both undoped and nickel doped nanocrystalline bismuth ferrite due to its close dimension of crystallite size with magnetic domains leading to break-down of frustrated spin cycloidal moment. The superparamagnetism behaviour is more pronounced for the nickel doped BFO though magnetic saturation is slightly higher for the undoped nanocrystalline bismuth ferrite.

Subcutaneous Zygomycosis is a rare opportunistic fungal infection caused by Basidiobolus ranarum. Though this entity is endemic in South India, limited numbers of cases have been reported from this part of the country. We report a case of subcutaneous zygomycosis in a 25 year old lady who presented with a nontender, firm to hard swelling over the upper-left arm. Finger was easily inserted below the indurated edge. Histopathology revealed suppurative granuloma with aseptate hyphae. Patient responded excellently to saturated solution of potassium iodide in subsequent visits.

Lupus vulgaris is a chronic paucibacillary form of cutaneous tuberculosis occurring in a person with a moderate to high degree of immunity. It commonly occurs over the buttocks and trunk in India. Involvement of the genitalia is uncommon, and lesions involving the penis, extremely rare with few cases reported worldwide. There also exists a confusion regarding nosology of tuberculosis of the genitalia. A brief discussion and review of literature are being discussed along with the report of a case of genital tuberculosis involving the glans penis.

Understanding the mechanisms of sodium (Na+) influx, effective compartmentalization, and efflux in higher plants is crucial to manipulate Na+ accumulation and assure the maintenance of low Na+ concentration in the cytosol and, hence, plant tolerance to salt stress. Na+ influx across the plasma membrane in the roots occur mainly via nonselective cation channels (NSCCs). Na+ is compartmentalized into vacuoles by Na+/H+ exchangers (NHXs). Na+ efflux from the plant roots is mediated by the activity of Na+/H+ antiporters catalyzed by the salt overly sensitive 1 (SOS1) protein. In animals, ouabain (OU)-sensitive Na+, K+-ATPase (a P-type ATPase) mediates sodium efflux. The evolution of P-type ATPases in higher plants does not exclude the possibility of sodium efflux mechanisms similar to the Na+, K+-ATPase-dependent mechanisms characteristic of animal cells. Using novel fluorescence imaging and spectrofluorometric methodologies, an OU-sensitive sodium efflux system has recently been reported to be physiologically active in roots. This review summarizes and analyzes the current knowledge on Na+ influx, compartmentalization, and efflux in higher plants in response to salt stress.

A 58-year-old lady presented with polyarthritis followed by multiple shiny erythematous dome-shaped papulonodules mainly over the face, around joints and coral bead sign on fingers without any mucosal involvement. Characteristic histopathology with well-defined dermal infiltrate consisting of multinucleated giant cells and large macrophages having abundant eosinophilic cytoplasm clinched the diagnosis of multicentric reticulohistiocytosis.