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  • The ITA notifies wrestler Tsogbadrakh Tseveensuren of an apparent anti-doping rule violation

    The ITA notifies wrestler Tsogbadrakh Tseveensuren of an apparent anti-doping rule violation

    The ITA reports that a sample collected from Tsogbadrakh Tseveensuren, a wrestler from Mongolia, during an in-competition testing mission at the Senior Asian Championships on 29 March 2025 has returned an AAF¹ for exogenous testosterone.

    Exogenous testosterone is prohibited under the WADA Prohibited List as S1.1 Anabolic Androgenic Steroids. Exogenous testosterone is prohibited at all times (in- and out-of-competition) and is a non-specified substance. Testosterone is the principal androgenic steroid and is associated with the promotion of muscle growth and increased strength, power and speed.

    The athlete has been informed of the case and has the right to request the analysis of the B-sample.

    If the B-sample analysis is requested and confirms the result of the A-sample, the case will be considered as a confirmed anti-doping rule violation. If the B-sample analysis is not requested, the case will also go ahead as a confirmed anti-doping rule violation. The athlete will have the opportunity to present his explanations for the result.

    Further, in accordance with the World Anti-Doping Code and article 7.4.1 of the UWW anti-doping rules, a mandatory provisional suspension has been imposed on the athlete. The athlete has the right to challenge the provisional suspension and ask for its lifting.

    Pursuant to the UWW’s delegation of its anti-doping program to the ITA, the prosecution of the case is being handled entirely by the ITA. Given that the case is underway, there will be no further comments made.

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  • WP U18s down hosts while Border CD and Bulls U16s share spoils at FNB Girls Weeks

    WP U18s down hosts while Border CD and Bulls U16s share spoils at FNB Girls Weeks

    WP and the Bulls claimed wins on Friday to finish the U18 Girls Week unbeaten, while Eastern Province, the Limpopo Blue Bulls, South Western Districts, the Pumas, Border and KwaZulu-Natal secured third-round victories to end their campaigns on a high.

    WP got off to a slow start in the final match against the Lions, but cracked into gear after half-time. The girls from the Cape scored five unanswered tries and 31 points in the second stanza, with flyhalf Nuha Levy contributing a try as well as three conversions.

    Earlier in the day, No 8 Amanda Seokotsa scored a hat-trick in the Limpopo Blue Bulls’ 31-15 win over the Griffons, while loosehead prop Jessica Ejeleonu touched down three times for the Valke in the East Rand outfit’s 27-25 loss to the Pumas.

    In the final round of the U16 Girls Week, the Lions beat WP 17-7 to finish their campaign with three consecutive wins.

    Border Country Districts drew 12-12 with the Bulls in the last game of the tournament, with the Eastern Cape side ending their campaign unbeaten.

    The girls from Border CD led 7-0 at the break, before the Bulls hit back with two tries after half-time. Just as the game was slipping away, loosehead prop Endinako Fetumane crossed the line for Border, ensuring that her side came away with a draw.

    FNB U18 Girls Week day three results (Friday, 4 July 2025):
    EP 12 (5) Zimbabwe 0 (0)
    Griffons 15 (0) Limpopo Blue Bulls 31 (12)
    Leopards 12 (12) SWD 22 (0)
    Valke 25 (15) Pumas 27 (0)
    Griquas 0 (0) Border 41 (12)
    Blue Bulls 19 (12) Boland 12 (0)
    Free State 0 (0) KwaZulu-Natal 38 (17)
    WP 31 (0) Golden Lions 5 (5)

    FNB U16 Girls Week day three results (Friday, 4 July 2025):
    Free State 0 (0) Zimbabwe 5 (0)
    Griquas 0 (0) Griffons 17 (5)
    Border 17 (12) Pumas 7 (0)
    SWD 20 (10) Limpopo Blue Bulls 27 (0)
    Valke 0 (0) Golden Lions Invitational XV 20 (10)
    Leopards 0 (0) KwaZulu-Natal 38 (24)
    Golden Lions 17 (12) WP 7 (0)
    Boland 7 (0) EP 13 (13)
    Border Country Districts 12 (7) Blue Bulls 12 (0)

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  • How AI Helps Maintain the Linux Kernel

    How AI Helps Maintain the Linux Kernel

    Meet AUTOSEL, a Linux maintainer that helps keep the kernel stable.

    AUTOSEL is a script, one that uses a Large Language Model (LLM) to complete its task.

    It does a thankless job, one loathed by all kernel maintainers, that of backporting patches.

    Backporting patches is a “very tedious and frustrating process” that “doesn’t scale,” said NVIDIA Distinguished Software Engineer Sasha Levin, in a talk at the Open Source Summit. The presentation focused on how AI is starting to be used in the Linux kernel community to help keep up with the Herculean tasks of maintaining the Linux kernel.

    It may not be writing exciting new features for the open source operating system kernel yet, but AI has excelled in tasks that are mind-numbingly repetitive yet still necessary. In other words, AI is already making the lives of Linux kernel developers easier, said Levin, who helps maintain the Linux Kernel Stable and LTS trees.

    Patch Inspection

    As the world’s single largest open source project, the Linux kernel gets updated and upgraded … a lot.

    The pace has remained constant: As many as 10,000 new patches have landed in the mainline kernel over a 10-week period.

    Stable and Long-Term Support (LTS) kernel maintainers usually review around 100 patches per day, every day, including weekends and holidays.

    Only a few, about 5-10, turn out to be suitable for backporting.

    Levin’s AUTOSEL, written in Rust, takes a first pass at incoming commits, looking for similarities across submitted commits and past backporting decisions, and suggesting only those to human committers to seem to be worthy of closer review.

    AUTOSEL is built from multiple LLMs, with each LLM used for a particular strength, as well as for cross-validation to reduce errors and hallucinations.

    For each commit, the tool creates mathematical representations (or “embeddings”) of the text that preserve semantic meaning for every commit in the kernel’s history, making them easily comparable.

    For human maintainers, the tools cuts down the number of commits that humans have to review. It even explains its reasoning in an email.

    Know Your Tools

    Like any other tool, the value of an LLM corresponds to how well it is understood by it user.

    You can think of Large Language Models as the next generation of compilers, providing developers with a jump in productivity, Levin said. They act like “massive state machines,” though what is unusual about them is that they perform state transitions in a probabilistic, rather than deterministic, manner.

    They are good at matching patterns given a huge number of parameters and an input provided by a user. A “temperature” parameter controls how probabilistic the LLM is, or how liberally it interprets its material.

    Other Uses

    And like any other technology, LLMs are first being tested in minor tasks.

    LLMs excel at “small, well-defined tasks.” Levin said.

    One such use is code generation and refactoring. Tightly-defined bug fixes, or converting code to other forms, such as standard APIs, are good tasks.

    For the 6.15 kernel release, Levin had an LLM write a patch to convert the open-coded hash table implementation to a standard API.

    Linux kernel 6.16 included git-resolve. This tool resolves incomplete or incorrect commit IDs, a nagging issue for core developers, though not one that occurs often enough to spend a lot of time manually writing a tool to figure out which commit an incomplete SHA-1 is actually connected to.

    It took Levin all of 20 minutes to work with the LLM to create the tool.

    It would take an engineer about half a day to create such a tool, making it not worth the effort given the relative rarity of the issue it addressed. Plus the LLM did a lot of extra credit: It created a set of self-tests and even documentation, which a human engineer would have done begrudgingly if at all.

    There’s no end of clean-up tasks that could be done with the kernel, Levin said. An LLM could help non-native English speakers write descriptive commit messages.

    CVE Classification

    Another tedious chore is classifying security vulnerabilities (CVEs), a task that the Linux kernel community took on in 2024.

    The work involves inspecting commits to see if they address security issues.

    Originally, a set of “hacky Bash scripts” was written to help.

    LLMs were used to replace the scripts with a set of far more refined tools written in Rust, which included a full set of testing tools and documentation.

    Using AUTOSEL as a launching point, a CVE classifier uses LLMs to identify commits that address security issues, and then goes on to check the vulnerability hasn’t already addressed in a previous patch. This is an overwhelming task for humans, given the 40 million lines of code that make up the Linux kernel.

    LLMs can understand the semantic meaning of the commits, which provides for a far more comprehensive matching capability. A Retrieval Augmented Generation (RAG) cycle pulls in the kernel’s development history and documentation (e.g., Git repositories) to minimize hallucinations.

    The LLMs effectively act as AI agents, Levin noted. They can run git commands, such as git blame, directly against the code repository to learn from the history of the kernel development itself.

    In summary, AI has thus far helped Linux scale its maintenance efforts, while enhancing consistency and reducing manual labor for tedious tasks.


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  • Free UV packing tool Packer-IO 1.3 now integrates directly in Blender

    Free UV packing tool Packer-IO 1.3 now integrates directly in Blender

    Plugin developer 3d-io has released Packer-IO 1.3, the latest version of the free standalone UV packing application for games, motion graphics, VFX and visualization artists.

    New features include support for real-world scene scale units, and for texel density, making it possible for games artists to maintain consistent texture resolution across models.

    3dio has also released a separate free Blender integration plugin, UnwrellaConnect, which makes it possible to use Packer-IO directly inside the open-source 3D software.

    An efficient standalone UV packing tool for organic and hard surface models
    First released last year, Packer-IO is a free standalone UV packing tool.

    It automatically arranges the UV islands of an imported 3D model to minimise wasted UV space, reducing the total file sizes of its texture maps.

    The software can be used on both hard surface and organic models, and supports tiled UV layouts, used in applications like ZBrush.

    It works with assets with “thousands of charts and millions of polygons”, and is resolution-independent, so packing times remain constant, regardless of the resolution of the textures.

    However, it is currently purely a UV packing tool: it doesn’t unwrap the UVs of a model first. You can find more details in our original story on Packer-IO 1.0.

    Now supports scale units and texel density
    3d-io has now released its first feature updates to the software, in the shape of Packer-IO 1.2, which came out last month, and Packer-IO 1.3, which came out earlier this week.

    New features in version 1.2 include scale-aware packing, with users now able to specify real-world scene scale units, including both metric and imperial measurements.

    Games artists get support for texel density: it is now possible to specify a target resolution in pixels per centimeter, so that packed textures look visually consistent with those of other assets.

    Version 1.3 provides “vastly improved” hole filling, with Packer-IO packing smaller UV islands into the space left between larger islands more intelligently.

    New UnwrellaConnect plugin makes it possible to pack UVs directly inside Blender
    3d-io has also released a free connector plugin for Blender, UnwrellaConnect, which integrates Packer-IO with Blender’s UI, making it possible to pack UVs of models directly inside Blender.

    It supersedes UV-Packer for Blender, 3d-io’s old Blender plugin, which was based on the same core technology.

    The Blender download link on the UV-Packer website has now been redirected, although the other editions, UV-Packer for 3ds Max and UV-Packer for Unreal Engine, are still available.

    So how do Packer-IO and UnwrellaConnect differ from UVPacker for Blender?
    If you already have UV-Packer for Blender, one reason to update to Packer-IO and UnwrellaConnect would be better integration with the other tools in your production pipeline.

    Packer-IO itself supports 3D models imported from any DCC app, while UnwrellaConnect – as the name suggests – also works with Unwrella-IO, 3d-io’s commercial UV unwrapping tool.

    Packer-IO also features a more streamlined UI and workflow than previous UV packing tools.

    Licensing and system requirements
    Packer-IO 1.3 is compatible with Windows 10+ and macOS 10.15+. The software is free, and is licensed for use in commercial projects.

    UnwrellaConnect is compatible with Blender 4.2+. Source code is available under a MIT license.

    Download free standalone UV packing software Packer-IO from 3d-io’s product website

    Download free Blender integration plugin UnwrellaConnect from the plugin’s GitHub repository

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  • Scientists make ground breaking discovery on new organism that gives a new perspective of life

    A microbe ‘challenging’ the distinction between cellular life and viruses has accidentally been discovered, and it could apparently ‘reshape our understanding of cellular evolution’.

    Scientific understanding of viruses emerged in the 1890s, while researchers have been learning about cells in general since the 17th century.

    However, despite so much time passing, experts are still discovering head-scratching entities that are stretching and changing everything we know about science today.

    Recently, researchers from Dalhousie University accidentally uncovered the provisionally named microbe Sukunaarchaeum mirabile within the marine plankton Citharistes regius.

    It’s understood that the discovery was made when the Canadian and Japanese teams found a loop of DNA in the specific plankton that didn’t match any species they knew about.

    Eventually, it was determined that this loop belonged to the domain Archaea – microorganisms that ‘define the limits of life on earth’.

    Much like bacteria, archaea are single-celled organisms lacking a membrane-bound nucleus that have been found in some of the most extreme environments on Earth, the Microbiology Society states.

    The new discovery could reshape our understanding of cellular evolution (Getty Stock Image)

    The new discovery could reshape our understanding of cellular evolution (Getty Stock Image)

    After researching the tiny cell further, scientists have discovered Sukunaarchaeum – named after a Japanese deity of small stature – has a minuscule genome consisting of 238,000 base pairs.

    This extreme genome reduction is actually half the size of the smallest previously known archaeal genome, which was 490 kbp.

    According to research published in the general-purpose open repository Zenodo and the bioRxiv server, this new discovery’s genome is “profoundly stripped‑down, lacking virtually all recognizable metabolic pathways, and primarily encoding the machinery for its replicative core: DNA replication, transcription, and translation.

    Researchers from Canada and Japan made the discovery (Getty Stock Image)

    Researchers from Canada and Japan made the discovery (Getty Stock Image)

    “This suggests an unprecedented level of metabolic dependence on a host, a condition that challenges the functional distinctions between minimal cellular life and viruses.”

    This little cellular oddity carries traits of both a virus and a living cell but relies heavily on its host for life.

    And, unlike a virus, it has required genes capable of building its own ribosomes and messenger RNA, wrote Men’s Journal.

    These are the ‘basic building blocks enabling organisms to translate genetic code into protein’, which the publication states viruses cannot do on their own.

    However, like a virus, it does offload some biological functions onto its host, relies on the host to carry out tasks, and is dedicated to replicating itself, Metro reported.

    Sukunaarchaeum’s discovery apparently ‘pushes the conventional boundaries of cellular life and highlights the vast unexplored biological novelty within microbial interactions,’ according to the team, led by molecular biologist Ryo Harada.

    They plan to further explore symbiotic systems to see whether more ‘extraordinary life forms may appear’, which could reshape our understanding of cellular evolution.

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  • Surviving Unrepaired Tetralogy of Fallot to 43 Years in a Low-Resource

    Surviving Unrepaired Tetralogy of Fallot to 43 Years in a Low-Resource

    Introduction

    Tetralogy of Fallot (ToF) is a congenital cyanotic heart defect, first described in detail by Étienne-Louis Fallot in 1888. It is characterized by a combination of four distinct anatomical abnormalities: right ventricular (RV) hypertrophy, a ventricular septal defect (VSD), obstruction of the right ventricular outflow tract (RVOT), and an overriding aorta. These structural anomalies result in altered hemodynamics, reducing pulmonary blood flow and systemic cyanosis.1 Early primary repair of Tetralogy of Fallot (ToF) has been advocated since the 1970s and is now routinely performed with excellent outcomes.2 This approach has become the standard of care, as it promptly addresses the anatomical abnormalities and associated hemodynamic consequences, reducing long-term morbidity and mortality. However, despite the widespread adoption of early surgical intervention, occasional cases of patients who have not undergone repair survive into adulthood.3,4 However, delaying the diagnosis and late intervention are highly associated with poor outcomes.5 According to large observational series, 24% of individuals with an uncorrected TOF die before the age of 10, and only 4% survive beyond their thirties.6,7. We present a unique case of an individual with uncorrected Tetralogy of Fallot (TOF) who has survived into adulthood with a relatively preserved quality of life despite the absence of surgical intervention. The lack of corrective surgery was primarily due to financial constraints and limited access to specialized cardiovascular care. The patient resides in Somalia, a low-income country where healthcare infrastructure remains underdeveloped, and access to advanced medical and surgical interventions is severely restricted. This case underscores the significant challenges faced by individuals with congenital heart disease (CHD) in resource-limited settings. It highlights the urgent need for improved access to pediatric and adult congenital cardiac care in such environments.

    Case Presentation

    A 43-year-old male presented with a history of recurrent syncope, reporting three episodes over the past six months. The most recent episode occurred at approximately 3:00 AM, during which the patient was found lying unresponsive on his bed by his family and was subsequently rushed to the hospital. The patient has a longstanding history of exertional dyspnea dating back to childhood, which was particularly pronounced during activities such as climbing hills. Due to his family’s nomadic lifestyle, he was often transported on camels during travels to accommodate his physical limitations. Additionally, the patient reported episodes of epistaxis and hemoptysis, further complicating his clinical picture.

    The patient’s past medical history includes a diagnosis of congenital heart disease of unknown type in 1997. Despite being referred to a cardiac center in Djibouti, a neighboring country, for further management, financial constraints prevented him from accessing specialized care. Over the years, the patient has experienced progressive exertional dyspnea, which has significantly impacted his quality of life and occupational capacity. Initially, he worked in charcoal production and later as a painter, but he was forced to retire due to worsening symptoms. He is the father of six children and has been the primary provider for his family.

    Physical Examination

    General Appearance

    The patient appeared to be in no acute distress and exhibited a normal overall appearance without signs of cachexia.

    Vital Signs Were

    Blood pressure 110/60 mmHg, heart rate 80 beats/minute, respiratory rate 18 breaths/minute, temperature 35.8 °C, and oxygen saturation 85% on room air.

    General Examination

    • Clubbing: Grade 3 clubbing was observed see Figure 5.
    • Cyanosis: No cyanosis was noted.
    • Edema: No peripheral edema was present.

    Cardiovascular System (CVS)

    • S1 and s2 are audible with a pansystolic murmur, graded 3/6 in intensity, was auscultated. The murmur was most prominent in the tricuspid and mitral areas but was not associated with a palpable thrill.

    Abdomen

    • The abdomen was soft and non-tender on palpation.
    • No abdominal swelling or organomegaly was detected.

    Peripheral Examination

    • No ankle edema or other signs of peripheral vascular compromise were observed.

    Nervous Examination

    • A brief neurological assessment showed the patient to be alert and fully oriented to person, place, and time. There were no obvious motor or sensory impairments. Examination of cranial nerves II through XII revealed no gross abnormalities. Additionally, there were no clinical signs suggestive of meningeal irritation.

    Investigations

    Complete Blood Count (CBC)

    • Polycythemia: Hemoglobin (Hb) level was elevated at 21 mg/dL, indicative of secondary polycythemia, likely due to chronic hypoxemia associated with congenital heart disease.
    • Thrombocytopenia: A Low platelet count was noted, possibly related to chronic disease or other underlying factors.

    Echocardiographic evaluation of the patient revealed a large malalignment subaortic ventricular septal defect (VSD)with an overriding aorta of less than 50%, indicative of abnormal conal septal development. Right ventricular hypertrophy (RVH) was observed, consistent with chronic pressure overload. Infundibular pulmonary stenosis was noted, contributing to right ventricular outflow obstruction. Additionally, an interatrial septal (IAS) aneurysm was identified, suggesting a structural abnormality that may have clinical significance (Figures 1 and 2).

    Figure 1 Is a long-axis view demonstrating the VSD with color Doppler imaging, showing flow across the defect penetrating the interventricular septum.

    Figure 2 Is an apical four-chamber view providing additional visualization of the VSD.

    Assessment

    • Tetralogy of Fallot (ToF): Known congenital heart defect with concerns for arrhythmias due to recent syncope.
    • Possible Old Inferior Myocardial Infarction (MI): ECG shows pathological Q waves in inferior leads, possibly due to chronic hypoxemia or coronary artery disease.
    • Secondary Polycythemia: Elevated hemoglobin (21 mg/dL) as a compensatory response to chronic hypoxemia, increasing thromboembolic risk.
    • Thrombocytopenia: Low platelet count, possibly secondary to chronic disease or polycythemia.

    Plan

    • Medical Management:

      • Aspirin (81 mg daily): To reduce thromboembolic risk from severe polycythemia and possible atherosclerosis indicated by ECG.
      • Atorvastatin (20 mg daily): Secondary prevention for suspected old inferior MI despite unknown lipid levels.
      • Hydroxyurea (500 mg daily): To control symptomatic secondary polycythemia by lowering erythropoiesis and blood viscosity.
      • Home Oxygen Therapy (as needed): To relieve chronic hypoxemia symptoms, especially exertional dyspnea.

    • Phlebotomy: Weekly 250 mL blood transfusion to manage polycythemia, with caution due to thrombocytopenia.
    • Further Investigation: Holter monitoring for arrhythmias.
    • Referral for Cardiac Surgery: Consideration for pulmonary valve replacement or complete repair.
    • Lifestyle & Follow-up: Avoid strenuous activity, and regularly monitor hemoglobin, platelets, and cardiac function.

    Electrocardiogram (ECG)

    • Rate: 75 beats per minute.
    • Rhythm: Sinus rhythm.
    • Axis: Extreme right axis deviation.
    • P Wave: P-pulmonale (tall, peaked P waves in leads II, III, and aVF) suggests right atrial enlargement.
    • Q Wave: Pathological Q waves were observed in the inferior leads (II, III, and aVF), suggesting a possible old inferior wall myocardial infarction.
    • R Wave:

      1. Prominent R wave in V1 and aVR.
      2. Deep S wave in V5 and V6.
      3. Poor R-wave progression across the precordial leads (Figure 3).

        Figure 3 ECG showing right ventricular hypertrophy, right atrial enlargement (P-pulmonale), and pathological Q waves in inferior leads suggest an old inferior wall myocardial infarction.

    • Findings:

      • Right Ventricular Hypertrophy (RVH): Suggested by the prominent R wave in V1 and deep S wave in V5/V6.
      • P-pulmonale: Indicative of right atrial enlargement, likely secondary to pulmonary hypertension or chronic right heart strain.
      • Old Infarction: Pathological Q waves in the inferior leads raise the possibility of a prior inferior wall myocardial infarction.

    Chest X-Ray

    • The chest X-ray reveals characteristics of Tetralogy of Fallot, notably a boot-shaped heart caused by enlargement of the right ventricle (Figure 4).

      Figure 4 Chest X-ray showing features of tetralogy of Fallot, including a boot-shaped heart due to right ventricular hypertrophy.

    Physical Appearance

    • Hand of the patient showing evidence of digital clubbing (Figure 5).

      Figure 5 Hand of the patient showing evidence of digital clubbing.

    Discussion

    Tetralogy of Fallot (TOF) is a congenital cardiac anomaly characterized by a ventricular septal defect, right ventricular outflow tract obstruction, overriding of the aortic root, and right ventricular hypertrophy. It occurs in approximately 3 per 10000 live births, accounting for 7–10% of all congenital heart defects. Clinical presentation typically occurs in the neonatal period, with cyanosis varying in severity based on the degree of right ventricular outflow obstruction. The etiology is multifactorial, with genetic and environmental factors playing a role. Maternal conditions such as diabetes and phenylketonuria, as well as chromosomal anomalies like trisomies 21, 18, and 13, have been associated with TOF, though recent evidence suggests a stronger link with 22q11.2 microdeletion. The recurrence risk in affected families is approximately 3%.8

    In diagnosing congenital heart diseases like Tetralogy of Fallot (ToF), readily available tools such as electrocardiography (ECG) and echocardiography are indispensable, offering a non-invasive approach. An ECG can reveal right axis deviation and right ventricular hypertrophy, indicative of the strain on the heart caused by ToF. Furthermore, echocardiography (2D ECHO) is crucial for confirming the diagnosis of ToF, as it can visualize the key anatomical defects, including ventricular septal defect (VSD), overriding aorta, and right ventricular outflow tract (RVOT) obstruction.9

    While ECG and standard echocardiography are essential for the initial diagnosis and monitoring of Tetralogy of Fallot (ToF), particularly in resource-limited settings due to their accessibility, advanced imaging modalities are often required for comprehensive anatomical and hemodynamic evaluation. Cardiac MRI (cMRI) is central in assessing ventricular function, pulmonary valve pathology, and right ventricular outflow tract (RVOT) morphology. Emerging techniques such as 4D-flow MRI enhance diagnostic precision by enabling dynamic flow analysis, offering insights into adverse hemodynamic patterns, and assisting with risk stratification and intervention planning.10 While cardiac catheterization remains the gold standard for direct hemodynamic measurements and detailed visualization of pulmonary arteries or complex vascular anomalies like Major Aortopulmonary Collateral Arteries (MAPCAs), its use is often limited in low-resource environments. Therefore, ECG and echocardiography remain indispensable tools for initial evaluation and follow-up in such settings.9 In our patient, ECG and echocardiography were indispensable for diagnosing Tof.

    Tetralogy of Fallot (TOF) is a cyanotic congenital heart disease associated with high mortality rates among unrepaired patients. Survival beyond 20 years is limited to approximately 10%, with only 3% reaching 40. In contrast, over 90% of patients undergoing surgical repair survive into adulthood. In developed countries, most individuals with TOF receive timely surgical intervention, which alleviates right ventricular outflow tract (RVOT) obstruction and significantly reduces mortality. However, in low-resource settings, access to surgical repair remains limited, particularly among patients from low socioeconomic backgrounds. This disparity contributes to poorer long-term outcomes and increased mortality in these populations.11

    In some cases, patients may not receive an accurate diagnosis during childhood, as was observed in our case. The first clinical suspicion of Tetralogy of Fallot (TOF) only arose when the patient reached adulthood. Confirming the diagnosis required advanced imaging studies, which were often financially inaccessible and frequently unavailable in his setting, both during initial assessment and routine follow-up. The lack of continuous monitoring and access to diagnostic tools contributed significantly to the delayed diagnosis and management of his condition. This case highlights the critical importance of making bedside echocardiography available, even in resource-limited environments. Point-of-care ultrasound can enable earlier detection and timely intervention in congenital heart diseases, ultimately improving patient outcomes.

    In the electrocardiogram (ECG) of our patient, the presence of QS waves in the inferior leads raised suspicion of an inferior myocardial infarction (MI). The relationship between myocardial infarction and Tetralogy of Fallot (TOF) is reported in the literature. A case from Turkey described a patient with TOF who experienced an MI, providing valuable insights into this uncommon association. In that case, the absence of resting cyanosis suggested a minor right-to-left shunt, potentially explaining the patient’s prolonged survival. However, following the myocardial infarction, both ventricles rapidly deteriorated, leading to severe heart failure and early mortality.12.

    The patient, a 43-year-old man, was admitted with chest pain, dyspnea, and diaphoresis. His medical history revealed dyspnea, exertional cyanosis, and palpitations since childhood. He had been diagnosed with TOF 13 years earlier, at which time cardiac catheterization was performed. However, he declined TOF corrective surgery, which may have contributed to his later cardiovascular complications.12 This case underscores the complex interplay between congenital heart defects and ischemic heart disease, highlighting the need for careful cardiovascular risk assessment in patients with uncorrected TOF. In the literature, several cases also describe similar situations, where the coexistence of TOF and MI significantly worsens the prognosis.13

    In our patient, syncope raised suspicion of an underlying arrhythmia. Syncope is a concerning symptom in individuals with repaired Tetralogy of Fallot (TOF). It is often associated with arrhythmias and conduction abnormalities, common long-term sequelae of surgical repair. While advancements in surgical techniques have significantly improved survival rates, residual cardiac abnormalities, scarring from patch material, atriotomy, and ventriculotomy contribute to the development of rhythm disturbances.14 However, cases of arrhythmias have also been reported in patients with unrepaired TOF.15 Similar pathophysiological mechanisms could potentially account for the syncopal episode observed in our patient.

    Ideally, ambulatory ECG monitoring—such as a Holter monitor—would have been indicated to assess for transient arrhythmias that might not be captured on routine ECG. Contemporary diagnostic strategies often rely on a spectrum of prolonged monitoring modalities, including traditional 24–48-hour Holter monitors, external loop recorders (ELRs), wearable patch devices, and implantable cardiac monitors (ICMs) for prolonged surveillance in select patients. These tools are critical for establishing symptom–rhythm correlation, especially when symptoms are infrequent or unpredictable.16 As Carrington et al (2022) emphasize, the choice of monitoring modality is primarily dictated by the frequency and nature of symptoms, with longer-duration or patient-activated monitors being particularly advantageous for episodic events. Unfortunately, such diagnostic tools were unavailable due to limitations inherent in our resource-constrained setting. Consequently, only a standard one-minute 12-lead ECG was performed, which showed no evidence of acute ischemia or arrhythmic disturbances at the recording time.

    Conclusion

    Tetralogy of Fallot (TOF) is a congenital heart defect with significant long-term risks, particularly in uncorrected cases. Our patient’s ECG suggested an inferior myocardial infarction, while syncope raised suspicion of arrhythmias, though Holter monitoring was unavailable. This case underscores the critical need for early diagnosis, timely surgical intervention, and continuous cardiac surveillance. In resource-limited settings, improving access to echocardiography and ambulatory ECG monitoring is essential for mitigating complications and improving outcomes in patients with uncorrected TOF.

    Authors’ Information

    • Dr Abdirahman A Warfaa: Cardiology Specialist at Darussalam Health Care and Cigaal Interventional Cardiology Center; also teaches at Amoud University.• Dr. Abdirahman Ibrahim Said: Internal Medicine Specialist at Borama Regional Hospital and Alaaleh Hospital; Clinical Coordinator for undergraduate programs at Amoud University College of Health Sciences.• Dr. Mohamoud Abdulahi: Orthopedics Specialist at Al-Hayat Hospital, Dar es Salaam Polyclinic, and Alaaleh Hospital; Dean of the School of Medicine, Amoud University.• Mohamed Said Hassan: Public Health Researcher; Head of the Medical School Research Committee.

    Manuscript Submission

    We confirm that this manuscript is original and has not been submitted elsewhere for publication.

    Ethical Approval

    The Ethical Committee of Amoud University granted ethical approval for this study, including permission for publication (Reference: 0100-AU-REC-2025).

    Consent for Publication

    The patient provided written informed consent after receiving a detailed explanation of the study’s purpose, procedures, and potential for publication. This consent included permission to publish all clinical details and associated images in this report. Patient anonymity has been preserved.

    Acknowledgments

    We extend our gratitude to the healthcare team at Darussalam Health Care for the care provided to the patient and the follow-up they gave.

    Author Contributions

    All authors contributed significantly to developing this case report, including the conception and interpretation of clinical findings. They participated in drafting, revising, or critically reviewing the manuscript; approved the final version to be published; agreed on the journal to which the case report was submitted; and took full responsibility for all aspects of the work.

    Funding

    This research received no financial support from external sources.

    Disclosure

    The authors declare that there are no conflicts of interest regarding the content or publication of this manuscript.

    References

    1. Boyer R, Kim HJ, Krishnan R. Management of unoperated tetralogy of Fallot in a 59-year-old patient. J Investig Med High Impact Case Reports. 2020;8. doi:10.1177/2324709620926908

    2. Van Arsdell GS, Maharaj GS, Tom J, et al. What is the optimal age for repair of tetralogy of Fallot? Circulation. 2000;102(19). doi:10.1161/circ.102.suppl_3.iii-123

    3. Dockery D. 1993. The New England journal of medicine was downloaded from nejm.org at Uniwersytet Jagiellonski Collegium Medicum on February 9, 2012. For personal use only. No other uses without permission. Copyright © 1993 Massachusetts medical society. All rights reserved. New Engl.

    4. Bertranou EG, Blackstone EH, Hazelrig JB, Turner ME, Kirklin JW. Life expectancy without surgery in tetralogy of Fallot. Am J Cardiol. 1978;42(3):458–466. doi:10.1016/0002-9149(78)90941-4

    5. Bernier PL, Stefanescu A, Samoukovic G, Tchervenkov CI. The challenge of congenital heart disease worldwide: epidemiologic and demographic facts. Semin Thorac Cardiovasc Surg Pediatr Card Surg Ann. 2010;13(1):26–34. doi:10.1053/j.pcsu.2010.02.005

    6. Campbell M. Natural history of cyanotic malformations and comparison of all common cardiac malformations. Br Heart J. 1972;34(1):3–8. doi:10.1136/hrt.34.1.3

    7. Roman S, Castellarin M. A uniquely compensated boot-shaped heart: a case of unrepaired tetralogy of Fallot with delayed symptom onset in adulthood. Chest. 2020;158(4):A280. doi:10.1016/j.chest.2020.08.281

    8. Bailliard F, Anderson RH. Tetralogy of Fallot. Orphanet J Rare Dis. 2009;4(1). doi:10.1186/1750-1172-4-2

    9. Kaur KS, Gupta ML, Rajput HS, Sajan C. Tetralogy of Fallot in adult – uncorrected and rare presentation: a case report. J Young Pharm. 2023;15(1):189–192. doi:10.5530/097515050444

    10. Schäfer M, Mawad W. Advanced imaging technologies for assessing tetralogy of Fallot: insights into flow dynamics. CJC Pediatr Congenit Hear Dis. 2023;2(6):380–392. doi:10.1016/j.cjcpc.2023.09.011

    11. Bhattarai P, Karki M, Purewal JK, Devarakonda Kumar. Unrepaired tetralogy of Fallot: a tale of delayed presentation and limited access to care. Chest. 2023;164(4):A386–A387. doi:10.1016/j.chest.2023.07.316

    12. Kudat H, Ahmet BS, Vakur A, Ozcan M. A case of Fallot tetralogy admitted for acute myocardial. Case Rep. 2020;4(1):4–5.

    13. Shteerman E, Singh V, Nero T, Lee M, Wilentz J, Menon V. Acute myocardial infarction in uncorrected tetralogy of Fallot. Circulation. 2002;106(4):1–2. doi:10.1161/01.cir.0000023883.39017.f4

    14. Ghazaryan N, Adamyan M, Khachatryan L, Hovakimyan T. Syncope in a pregnant woman with repaired Tetralogy of Fallot: a case report. Eur Heart J Case Reports. 2022;6(6):1–5. doi:10.1093/ehjcr/ytac209

    15. Gorla R, Macchi A, Franzoni I, et al. Unrepaired tetralogy of Fallot in an 85-year-old man. Congenit Heart Dis. 2012;7(5):1–4. doi:10.1111/j.1747-0803.2012.00642.x

    16. Carrington M, Providência R, Chahal AAC, et al. Monitoring and diagnosing intermittent arrhythmias: evidence-based guidance and role of novel monitoring strategies. Eur Heart J Open. 2022;2(6):1–10. doi:10.1093/ehjopen/oeac072

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  • Could signs of Mars life be hidden in its thick layers of clay?

    Could signs of Mars life be hidden in its thick layers of clay?

    The thick, mineral-rich layers of clay found on Mars suggest that the Red Planet harbored potentially life-hosting environments for long stretches in the ancient past, a new study suggests.

    Clays need liquid water to form. These layers are hundreds of feet thick and are thought to have formed roughly 3.7 billion years ago, under warmer and wetter conditions than currently prevail on Mars.

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  • Ratified: world records for Assefa, Stano and Dunfee | PRESS-RELEASES

    Ratified: world records for Assefa, Stano and Dunfee | PRESS-RELEASES

    Women’s marathon (women-only)
    2:15:50 Tigist Assefa (ETH) London, 27 April 2025

    Men’s 35km race walk
    2:21:40 Evan Dunfee (CAN) Dudince, 22 March 2025
    2:20:43 Massimo Stano (ITA) Podebrady, 18 May 2025

    World records set earlier this year by Tigist Assefa, Evan Dunfee and Massimo Stano have been ratified by World Athletics.

    Olympic silver medallist Assefa achieved her women-only world marathon record at the London Marathon on 27 April. The Ethiopian clocked 2:15:50 to improve the previous world record by 26 seconds to win the World Athletics Platinum Label road race.

    The previous world record of 2:16:16 had been set by Kenya’s Peres Jepchirchir in London on 21 April 2024.

    “When I crossed the line, I felt extreme happiness,” said Assefa.

    The performance, achieved in a women-only race, was the third-fastest marathon of Assefa’s career behind the 2:11:53 she ran to win in Berlin in 2023, a mark that at the time was a world record for a women’s marathon in a mixed race, and her 2:15:37 also from Berlin in 2022.

    Assefa’s 2:11:53 remains the second-fastest women’s marathon of all time behind the 2:09:56 achieved by Ruth Chepngetich to break Assefa’s world record in Chicago in October.

    “Having won today, what I am really thinking about going forward is to try and get my world record back for the marathon (in a mixed race),” Assefa added.

    Canada’s Dunfee set his world 35km race walk record at the Dudince 50 – a World Athletics Race Walking Tour Gold meeting – in Dudince, Slovakia, on 22 March.

    The world and Olympic bronze medallist’s time of 2:21:40 was seven seconds inside the previous world record of 2:21:47 set by Japan’s Masatora Kawano in Takahata on 27 October 2024.

    “I was well under pace but then lost a little time over the last seven kilometres,” said Dunfee. “I (then) got a little stressed out, but it was a dream come true.”

    Dunfee’s world record was improved by Italy’s Stano, who clocked 2:20:43 at the European Race Walking Team Championships in Podebrady, Czechia, on 18 May.

    The 2021 Olympic champion took the lead at 23km then wound up the pace to win by almost three minutes, improving the world record by 57 seconds.

    “The approach to the race was not to set out to break the world record, but the strategy was to close the last 20 kilometres as fast as possible,” said Stano. “That was my mission, then the world record was the consequence.”

    World Athletics

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  • #1 Nutrient You Should Eat to Reduce Skin Cancer Risk

    #1 Nutrient You Should Eat to Reduce Skin Cancer Risk

    • Skin cancer is the most common cancer in the U.S. and has multiple causes.
    • Wearing sunscreen and avoiding excess sun exposure are the best protection. 
    • Research shows antioxidants may also help guard against this common cancer.

    Spending time outside can boost your mood, promote better sleep and support your immune system (plus, it’s free!). The only drawback is that outdoor time also exposes you to the sun’s skin-damaging UV rays. Over time, that could set the stage for skin cancer, the most commonly diagnosed cancer in the United States. “By far, the top risk factor for developing skin cancer is unprotected UV exposure, followed by genetic predisposition,” says dermatologist Geeta Yadav, M.D. 

    There is good news, though. According to the Centers for Disease Control and Prevention,  many cases of skin cancer are largely preventable. Adopting safe sun habits like applying a broad-spectrum sunscreen, wearing a hat, sunglasses and clothes that cover your arms and legs, and staying in the shade can all lower your UV exposure and significantly reduce your risk. So can avoiding tanning beds, which also emit large amounts of UV light. 

    You can also bolster your skin’s defenses from the inside out by eating more antioxidants. While diet plays a smaller role in skin cancer prevention, research reveals that antioxidants can provide additional protection to safeguard your skin from this all-too-common cancer.

    How Antioxidants May Protect Against Skin Cancer

    Skin cancer occurs when abnormal skin cells develop in the skin’s outermost layer, called the epidermis. What causes those abnormal cells to develop and grow? The most common cause is DNA damage from exposure to UV rays, either from the sun or tanning beds. However, there are other risk factors too, like getting older or having a family history of skin cancer. You may also be more likely to develop skin cancer if you have blue or green eyes, red or blond hair, or have skin that’s fair or burns or freckles easily. 

    Of course, most of these risk factors are beyond your control. But there is one helpful step you can take, and that’s eating an antioxidant-rich diet. In fact, research has found that dietary antioxidants can help counteract some of the damage caused by UV exposure before it turns into cancer. And the list is long: selenium, zinc, copper, carotenoids, polyphenols and vitamins A, C and E may all be protective, according to research. 

    They Combat Oxidative Stress

    Exposure to UV light sets off a chain reaction that creates a storm of skin-damaging compounds called free radicals. That’s where antioxidants step in. “Antioxidants combat free radicals, unstable molecules that can damage cells and their DNA, proteins and lipids,” says Yadav. “When there are too many free radicals in the body to the point that antioxidants cannot help neutralize them, oxidative stress occurs, leading to cellular dysfunction. This dysfunction could manifest as early signs of aging, but it could also manifest as cancer.” Regularly consuming antioxidant-rich foods equips your body with the defenders needed to neutralize those free radicals before they cause long-term harm. 

    They May Prevent the Spread of Cancerous Cells

    Not all DNA damage leads to cancer. In fact, our bodies have a natural defense mechanism to kill off DNA-damaged cells before they turn cancerous and start to spread. However, it’s not foolproof, and some damage can fall through the cracks. Fortunately, research reveals that antioxidants called anthocyanins may help speed the process. While anthocyanins are found in lots of fruits and vegetables, one of the best sources for skin protection is berries. So, load up on these juicy fruits for an extra dose of prevention. 

    They Help Boost Internal Sun Protection

    Sunburns aren’t just painful. This inflammatory reaction in your skin can cause long-lasting damage.  Enter antioxidant-rich foods. Research has found that they help absorb some of the sun’s harmful UV rays and reduce inflammation to decrease the development of sunburn., For instance, one study found that carotenoids, antioxidants found in yellow, orange and red fruits and vegetables, could provide the equivalent sun protection to SPF 4 sunscreen. For the biggest bang, think tomatoes. They’re filled with a carotenoid called lycopene that’s been shown to guard against sun damage from the inside out. 

    Tips to Enjoy More Antioxidants

    If you’re gearing up to spend more time outdoors, these tips can help you provide your skin with an extra layer of antioxidant protection. 

    • Eat the Rainbow: An easy rule of thumb for adding more antioxidants to your diet is to add more color to your plate. Fruits and vegetables with bright, deep hues are often the richest source of these beneficial compounds. 
    • Brew a Cup of Green Tea: There’s a reason green tea is added to face creams, masks and serums. It’s rich in antioxidants called catechins that have been shown to calm UV-related skin inflammation. 
    • Savor Some Dark Chocolate: While chocolate may not prevent skin cancer, it contains inflammation-taming antioxidants called polyphenols that may improve skin hydration and circulation. Since dark chocolate contains the most polyphenols, the darker the chocolate, the better!

    Antioxidant-Rich Recipes to Try

    Our Expert Take

    Getting regular skin checks and practicing safe sun habits like applying sunscreen, wearing a hat and protective clothing, and staying in the shade may all help reduce your risk of skin cancer. While diet plays a much smaller role, research has found that antioxidants may offer additional protection. Antioxidants are believed to combat cancer-causing oxidative stress, slow the spread of cancer cells and boost your body’s internal defenses against inflammation and sunburn. And the best way to get more of them isn’t a pill or powder. It’s a diet rich in colorful fruits and vegetables. So, before you hit the beach, park or pool, head to the produce aisle!

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  • US Plans AI Chip Curbs on Malaysia, Thailand Over China Concerns

    US Plans AI Chip Curbs on Malaysia, Thailand Over China Concerns

    (Bloomberg) — President Donald Trump’s administration plans to restrict shipments of AI chips from the likes of Nvidia Corp. to Malaysia and Thailand, part of an effort to crack down on suspected semiconductor smuggling into China.

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    A draft rule from the Commerce Department seeks to prevent China — to which the US has effectively banned sales of Nvidia’s advanced AI processors — from obtaining those components through intermediaries in the two Southeast Asian nations, according to people familiar with the matter. The rule is not yet finalized and could still change, said the people, who requested anonymity to discuss private conversations.

    Officials plan to pair the Malaysia and Thailand controls with a formal rescission of global curbs from the so-called AI diffusion rule, the people said. That framework from the end of President Joe Biden’s term drew objections from US allies and tech companies, including Nvidia. Washington would maintain semiconductor restrictions targeting China — imposed in 2022 and ramped up several times since — as well as more than 40 other countries covered by a 2023 measure, which Biden officials designed to address smuggling concerns and increase visibility into key markets.

    All told, the regulation would mark the first formal step in Trump’s promised overhaul of his predecessor’s AI diffusion approach — after the Commerce Department said in May that it would supplant that Biden rule with its own “bold, inclusive strategy.” But the draft measure is far from a comprehensive replacement, the people said. It doesn’t answer, for example, questions about security conditions for the use of US chips in overseas data centers — a debate with particularly high stakes for the Middle East. It’s unclear whether Trump officials may ultimately regulate AI chip shipments to a wider swath of countries, beyond the Malaysia and Thailand additions.

    The Commerce Department didn’t respond to a request for comment. The agency has offered few specifics about its regulatory vision beyond what Secretary Howard Lutnick told lawmakers last month: The US will “allow our allies to buy AI chips, provided they’re run by an approved American data center operator, and the cloud that touches that data center is an approved American operator,” he said during congressional testimony.

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