Pontifical Bolivarian University

Multimodal electric transport systems demand substantial active and reactive energy, making power-quality management essential for ensuring efficient and reliable operation. This paper analyses reactive-energy transport in mass-transit networks and introduces a unified current-based framework that enables a consistent interpretation of the conventional power factor under harmonic distortion, fundamental unbalance, and short-term load fluctuation, without modifying its original definition. The framework enables a consistent assessment of compensation needs, independent of billing schemes, and is aligned with the way modern compensation equipment is specified and controlled. Applied to the Metro de Medellín system, field measurements and digital simulations show that traditional reactive-energy limits fail to distinguish between harmful and beneficial operating conditions, leading to disproportionate charges under the former Colombian regulation. Beyond this case, the proposed framework is directly applicable to other electric-mobility systems—including railways, trams, trolleybuses, and electric-bus networks—providing clearer technical signals for compensation planning and offering a comprehensive basis for future regulatory approaches that integrate multiple power-quality phenomena.

BackgroundBenign paroxysmal positional vertigo (BPPV) is the most common peripheral vestibular disorder. Although canalith repositioning maneuvers (CRMs) are highly effective, a substantial proportion of patients experience residual dizziness (RD) after successful repositioning. Betahistine has been proposed as an adjunctive therapy to facilitate recovery; however, its effectiveness in RD remains uncertain.AimsTo evaluate the efficacy and safety of betahistine in adults with BPPV who experience residual dizziness after canalith repositioning maneuvers.MethodsA systematic review was conducted in accordance with the PRISMA 2020 guidelines. PubMed/MEDLINE, Scopus, and Web of Science were searched from inception to 1 February 2026. Randomized controlled trials including adults with BPPV who were treated with CRMs and presented with residual dizziness were eligible. Betahistine administered as adjunctive therapy was compared with placebo, no treatment, maneuver alone, or other pharmacological interventions. Two reviewers independently performed study selection, data extraction, and risk of bias assessment using the JBI checklist. Due to heterogeneity, findings were synthesized narratively.ResultsFour randomized controlled trials published between 2012 and 2022, including approximately 418 participants, were included. Betahistine daily doses ranged from 36 to 48 mg/day, with treatment durations of 1–4 weeks. Outcomes assessed included symptom intensity (VAS), disability (DHI), participation measures, duration of RD, and clinical resolution. Two trials reported significant improvements in symptom reduction, disability scores, or probability of RD resolution with betahistine, whereas two studies found no clear differences in primary outcomes or final clinical resolution compared with controls. Methodological quality varied, with one study considered at low risk of bias and three presenting uncertainties in key domains.ConclusionBetahistine may provide symptomatic or functional improvement in selected patients with residual dizziness after CRMs, but current randomized evidence remains limited, heterogeneous, and methodologically uncertain. Routine or universal use is not supported. Further adequately powered trials with standardized RD definitions, comparable outcomes, longer follow-up, and objective vestibular assessments are needed to clarify its clinical role.Systematic Review Registrationhttps://www.crd.york.ac.uk/PROSPERO/view/CRD420261339853.

BACKGROUND:Metastatic myocardial calcification (MMC) is a rare complication of chronic kidney disease-mineral bone disorder (CKD-MBD), potentially mimicking infiltrative cardiomyopathies on cardiac imaging. CASE SUMMARY:A 30-year-old woman on peritoneal dialysis for IgA nephropathy presented with recurrent chest pain, elevated troponin, and severe hypertension. Coronary angiography was normal. Echocardiography revealed severe left ventricular hypertrophy. Initial cardiac magnetic resonance imaging showed focal edema; a follow-up study demonstrated diffuse midwall late gadolinium enhancement with myocardial nulling, raising concern for amyloidosis, but a markedly reduced native T1 challenged this diagnosis. Noncontrast computed tomography showing diffuse myocardial hyperattenuation confirmed MMC in the setting of severe secondary hyperparathyroidism and concurrent metastatic pulmonary calcification. Management included intensified CKD-MBD therapy and parathyroidectomy. DISCUSSION:MMC can closely mimic amyloidosis on magnetic resonance imaging. Multimodality imaging is essential for accurate diagnosis. TAKE-HOME MESSAGES:Multimodality imaging is key in differentiating infiltrative diseases. MMC should be considered in dialysis patients with secondary hyperparathyroidism.

Fibromyalgia is a widespread chronic pain condition affecting quality of life. Emotional distress and loneliness are factors commonly related to pain and suffering. However, no study has analyzed how all these variables interplay in individuals living with fibromyalgia. The study objective was to empirically test the relationships among loneliness, anxiety, depression, pain, and suffering in this population. Descriptive, observational, cross-sectional study. Structural equation modeling (SEM) was used to assess the relationships between loneliness, anxiety, and depression to the experience of pain and suffering in 317 fibromyalgia patients who attended a specialized pain management facility. Loneliness was positively associated with anxiety, pain, depression, and suffering. Moreover, in our sample, anxiety, depression, suffering, and pain demonstrated significant covariation. We also found that depression is positively related to pain and suffering. Our study demonstrates that loneliness in fibromyalgia is closely linked to anxiety, depression, pain, and suffering. Regular, comprehensive interventions that incorporate social support strategies may help reduce this burden.

BACKGROUND The incidence of fragility hip fractures (FHF) is increasing in older adults, and delirium often follows physical stress such as FHF. The Diagnostic and Statistical Manual of Mental Disorders, Fifth Edition (DSM-5) is the reference standard for diagnosing delirium in Thailand but requires specialized expertise. The Delirium Diagnostic Tool-Provisional (DDT-Pro) - a reliable and valid alternative that does not require specialist training - has not been evaluated in older Thai patients with FHF. This study aimed to translate and cross-culturally adapt the DDT-Pro to create a Thai version (DDT-Pro-TH), then determine its validity and reliability. MATERIAL AND METHODS A multidisciplinary team of nonpsychiatrists (orthopedists, geriatricians, anesthesiologists, physiatrists) and 2 DDT-Pro psychiatry experts performed forward and backward translation. Patients with FHF were informed about and consented to participation in this cross-sectional validation study. The DDT-Pro-TH and DSM-5 were independently utilized for delirium assessment before surgery and on postoperative days 1 and 2. Delirium diagnosed by DSM-5 served as the reference standard; DDT-Pro-TH positivity was defined as a score of 6 or lower. Validity was assessed with the area under the curve (AUC); reliability was measured using Cronbach's alpha and Cohen's kappa statistics. RESULTS One hundred ten patients with FHF participated. Internal consistency reliability (Cronbach's alpha) was 0.819 (95% CI, 0.783-0.851). Inter-rater reliability (Cohen's kappa) was 0.974 (95% CI, 0.962-0.982). Concurrent validity (AUC vs Thai DSM-5) was 0.959 (95% CI, 0.903-0.987). CONCLUSIONS The Thai version of the DDT-Pro is a highly reliable and valid instrument for diagnosing delirium in older patients with FHF.