Polyphenols are a group of diverse chemical compounds present in a wide range of plants. Various biological properties such as antiallergic, antiviral, antibacterial, anticarcinogenic, antiinflammatory, antithrombotic, vasodilatory, and hepatoprotective effect of different polyphenols have been reported in the scientific literature. The major classes of polyphenols are flavonoids, stilbenoids, lignans, and polyphenolic acids. Flavonoids are a large class of food constituents comprising flavones, isoflavanones, flavanones, flavonols, catechins, and anthocyanins sub-classes. Even with seemingly broad biological activities, their use is minimal clinically. Among the other concurrent problems such as limited bioavailability, rapid metabolism, untargeted delivery, the toxicity associated with these polyphenols has been a topic of concern lately. These polyphenols have been reported to result in different forms of toxicity that include organ toxicity, genotoxicity, mutagenicity, cytotoxicity, etc. In the present article, we have tried to unravel the toxicological aspect of these polyphenols to healthy cells. Further high-quality studies are needed to establish the clinical efficacy and toxicology concern leading to further exploration of these polyphenols.

The management of MF-CTCL is based on a "stage-based" approach and an evaluation by a multidisciplinary team is preferred. Initial treatment in patients with local (patch/ plaque) disease includes skin-directed therapies (localized or generalized), with the addition of systemic biologic therapy for refractory, or progressive disease. In patients with unfavorable prognostic features (e.g., folliculotropic or large-cell transformed MF, or B1 involvement) systemic biologic therapies may be introduced earlier in the treatment algorithm. Patients who do not respond to biologic therapy or those with very aggressive or extracutaneous disease may be treated with chemotherapy [1-3].TSEI represents an integral part in the treatment of advanced MF. TSEI is characterized by a favorable local toxicity profile with excellent response rates. The impact of TSEI on systemic progression remains unclear. A 75-YOAAM with stage IIB Cutaneous T-Cell Lymphoma had clinically indolent disease for many years. He then presented with multiple cutaneous lesions with increasing evolution of his disease. He received TSEI to 18 Gy in 12 fractions followed by additional boost to many sites. One month later, he presented with diffuse neck swelling, difficulty breathing, and hoarseness. PET/CT scan revealed diffuse systemic progression. Despite salvage radiation (RT) and chemotherapy, his disease quickly progressed further and was ultimately fatal. TSEI's impact on systemic progression of MF merits further investigation, especially in the context of clinicopathological evaluation of MF transformation and the potential value of combining novel immunotherapeutic agents like checkpoint inhibitors with RT to potentially further improve outcomes for such patients with aggressive transformation MFCTCL.

Abbreviations & Acronyms 99mTc-DTPA = technetium 99m-diethylene triamine pentaacetic acid CIC = clean intermittent catheterization GFR = glomerular filtration rate UTIs = urinary tract infections VCUG = voiding cystourethrography VUR = vesicoureteral reflux Objectives: To show the efficacy and safety of a novel modification of Studer's neobladder, herein defined as the "fez procedure." Methods: The medical records of 21 children (mean age 9.4 ± 1.3 years) who underwent the "fez procedure" at King Abdulaziz University Hospital, Jeddah, Saudi Arabia, to manage refractory poorly-compliant bladders and concomitantly obstructed megaureters were retrospectively reviewed. The patients had been previously managed by either preliminary cutaneous ureterostomy (17 patients) or temporary nephrostomy (four patients) to improve and stabilize the renal functions. The "fez procedure" entailed augmentation ileocystoplasty and the use of an afferent tubularized ileal loop for direct ureteroileal anastomosis. The augmented bladder together with the tubularized loop were fashioned as a "fez" with its tassel. The outcome measures were changes in cystometric capacity, bladder compliance, glomerular filtration rate, serum creatinine, technetium 99m-diethylene triamine pentaacetic acid diuretic renography (T1/2), ureteral diameter, vesicoureteral reflux, febrile urinary tract infections, continence and complications. Results: The mean study follow-up period was 52.5 ± 12.8 months. Means of changes of cystometric capacity (273.2 ± 60.9 mL) and bladder compliance (15.6 ± 4.2 mL/cm H 2 O) were significant (P < 0.0001). Resolution of ureteral obstruction was documented with improved T1/2 and ureteral diameter (P < 0.0001, each) of all patients. The initially improved renal functions after ureterostomies or nephrostomies were maintained after "fez surgery," with non-significant changes in the improved glomerular filtration rate (P = 0.22) and serum creatinine (P = 0.18). None of the patients experienced ureteral restenosis, vesicoureteral reflux, febrile urinary tract infections, incontinence or significant complications. Conclusions: The "fez procedure" represents a versatile and successful surgical option for these selected patients, as it offers improved bladder capacity/compliance, resolution of ureteral obstruction and vesicoureteral reflux, preservation of the renal function, control of urinary tract infections and urinary continence, and acceptable morbidity.