Effect of the SARS-CoV-2 pandemic on metabolic control in patients with type 2 diabetes: a 5-year cohort follow-up managed by a dynamic multidisciplinary team in Northeastern Mexico.

BACKGROUND: The SARS-CoV-2 pandemic brought a radical shift in the healthcare system and suboptimal care for vulnerable patients, such as those with Type 2 Diabetes Mellitus (T2D). Therefore, we compared metabolic control and macro/microvascular complications of patients with T2D before and throughout the three-year SARS-CoV-2 pandemic. RESEARCH DESIGN AND METHODS: A retrospective observational cohort of subjects with T2D studied from 2018 to 2022 in Northern Mexico was treated by a dynamic multidisciplinary team. Levels of Glycated hemoglobin (HbA1c), fasting serum glucose (FG), LDL-Cholesterol (LDL-C), blood pressure (BP), albuminuria, triglycerides, Body Mass Index (BMI), and FIB-4 score, micro and macrovascular complications were evaluated. RESULTS: A total of 999 patients were studied, 51.7% males with a mean (SD) age of 60.1 (12.7) years. Adequate glycemic control based on HbA1c increased by 15.2% and 42.3% in FSG (p < 0.001) between the beginning 2018 and the end of 2022. LDL-C control decreased by 5.1% between 2018 and 2022 (p < 0.001). Systolic BP control decreased by 2.6% (p < 0.001), whereas diastolic BP control increased by 1.8% (p = 0.01) between 2018 and 2022. Albuminuria control increased by 8.5% (p = 0.002). When comparing the Area Under the Curve (AUC) of metabolic parameters between patients who developed SARS-CoV-2 vs. those who did not, AUC was statistically higher in those who developed SARS-CoV-2 (p < 0.05). Diabetic neuropathy was the most prevalent microvascular complication (n = 35; 3.6%); ischemic heart disease was the most frequent macrovascular complication (n = 11;1.1%). CONCLUSIONS: A multidisciplinary dynamic team that adapts to the pandemic SARS-CoV-2 maintains and increases metabolic control in subjects with type 2 diabetes in Mexico. This represents a low percentage of chronic complications. The AUC of metabolic parameters of subjects with SARS-CoV-2 infection is higher, reflecting more variability in metabolic control.

Neural Network-Based Sum-Frequency Generation Spectra of Pure and Acidified Water Interfaces with Air.

The affinity of hydronium ions (H3O+) for the air-water interface is a crucial question in environmental chemistry. While sum-frequency generation (SFG) spectroscopy has been instrumental in indicating the preference of H3O+ for the interface, key questions persist regarding the molecular origin of the SFG spectral changes in acidified water. Here we combine nanosecond long neural network (NN) reactive simulations of pure and acidified water slabs with NN predictions of molecular dipoles and polarizabilities to calculate SFG spectra of long reactive trajectories including proton transfer events. Our simulations show that H3O+ ions cause two distinct changes in phase-resolved SFG spectra: first, a low-frequency tail due to the vibrations of H3O+ and its first hydration shell, analogous to the bulk proton continuum, and second, an enhanced hydrogen-bonded band due to the ion-induced static field polarizing molecules in deeper layers. Our calculations confirm that changes in the SFG spectra of acidic solutions are caused by hydronium ions preferentially residing at the interface.

How the Acidity of Water Droplets and Films Is Controlled by the Air-Water Interface.

Acidity is a key determinant of chemical reactivity in atmospheric aqueous aerosols and water microdroplets used for catalysis. However, many fundamental questions about these systems have remained elusive, including how their acidity differs from that of bulk solutions, the degree of heterogeneity between their core and surface, and how the acid-base properties are affected by their size. Here, we perform hybrid density functional theory (DFT)-quality neural network-based molecular simulations with explicit nuclear quantum effects and combine them with an analytic model to describe the pH and self-ion concentrations of droplets and films for sizes ranging from nm to µm. We determine how the acidity of water droplets and thin films is controlled by the properties of the air-water interface and by their surface-to-volume ratio. We show that while the pH is uniform in each system, hydronium and hydroxide ions exhibit concentration gradients that span the two outermost molecular layers, enriching the interface with hydronium cations and depleting it with hydroxide anions. Acidity depends strongly on the surface-to-volume ratio for system sizes below a few tens of nanometers, where the core becomes enriched in hydroxide ions and the pH increases as a result of hydronium stabilization at the interface. These results obtained for pure water systems have important implications for our understanding of chemical reactivity in atmospheric aerosols and for catalysis in aqueous microdroplets.

Acids at the Edge: Why Nitric and Formic Acid Dissociations at Air-Water Interfaces Depend on Depth and on Interface Specific Area.

Whether the air-water interface decreases or increases the acidity of simple organic and inorganic acids compared to the bulk is critically important in a broad range of environmental and biochemical processes. However, a consensus has not yet been achieved on this key question. Here we use machine learning-based reactive molecular dynamics simulations to study the dissociation of paradigmatic nitric and formic acids at the air-water interface. We show that the local acidity profile across the interface is determined by changes in acid and conjugate base solvation and that the acidity decreases abruptly over a transition region of a few molecular layers. At the interface, both acids are weaker than in the bulk due to desolvation. In contrast, acidities below the interface reach a plateau and are all the stronger compared to those in the bulk as the surface to volume ratio of the aqueous phase is large, due to the growing impact of the stabilization of the released proton at the surface of the water. These results imply that the measured degree of dissociation sensitively depends on the experimental probing length and system size and suggest a molecular explanation for the contrasting experimental results. The aerosol size dependence of acidity has important consequences for atmospheric chemistry.

Structural Damage of Jailed Guidewire During the Treatment of Coronary Bifurcation Lesions: A Microscopic Randomized Trial.

OBJECTIVES: The study sought to compare the safety (resistance to damage) and efficacy (ability to cross the side branch) of polymer-coated and non-polymer-coated guidewires in the jailed wire technique used during the percutaneous treatment of bifurcation lesions. BACKGROUND: The jailed wire technique is a useful strategy in the treatment of bifurcation lesions by provisional stenting. However, these wires can be damaged or even be broken during their removal. METHODS: We performed a randomized study in patients with bifurcation lesions treated by provisional stenting. The jailed wire technique was mandatory, and the types of guidewires, polymer-coated (n = 115) and non-polymer-coated (n = 120), were randomized. After the procedures, the wires were evaluated by stereoscopic microscopy. The induced damage in the wires was classified as follows: no damage, mild, moderate, or severe. RESULTS: The clinical characteristics were similar between patients treated with polymer-coated or non-polymer-coated wires. Polymer-coated wires were significantly (p < 0.001) more resistant to retrieval damage (only 2 wires showed mild damage) than were non-polymer-coated wires. However, 63 (55%) of the non-polymer-coated wires were damaged; 37 (32%), 24 (21%), and 2 (2%) had mild, moderate, and severe damage, respectively. Additionally, the jailed length of the wire was a factor contributing to the degree of wire damage. The time of side branch wiring was shorter in the polymer-coated wire group (19 ± 40 s vs. 42 ± 72 s; p < 0.05). CONCLUSIONS: Jailed wires during interventional procedures of bifurcation lesions commonly showed microscopic damage. Polymer-coated wires were more resistant to retrieval damage and were more efficient in crossing the side branch ostium than non-polymer-coated wires. (Jailed Wire Technique in the Treatment of Coronary Bifurcations Lesions With Stent: Stereoscopic Microscopy Study; NCT02516891).

Risk of headache, temporomandibular dysfunction, and local sensitization in male professional boxers: a case-control study.

OBJECTIVE: To evaluate differences in the incidence of headache, trigeminal nerve mechanosensitivity, and temporomandibular functionality in professional male boxers (exposed to repetitive craniofacial trauma) who were actively training and without severe previous injuries compared with handball players. DESIGN: Case-control study. SETTING: University-based physical therapy research clinic. PARTICIPANTS: Eighteen boxers (mean age, 23±4.61y) as the cases group, and 20 handball players as the comparison group (mean age, ±2y, and sex matched), were included. All participants (N=38) completed the assessment protocol. INTERVENTIONS: Not applicable. MAIN OUTCOME MEASURES: Measurements were taken of the headache impact (Headache Impact Test-6) and the pressure pain threshold over the trigeminal nerve sensory branches, the masseter muscle, and the tibialis anterior muscle. The secondary outcome measure included the temporomandibular function (Helkimo Clinic Index). RESULTS: The boxers showed slight mandibular function impairment, local muscular and neural sensitization, and a higher impact from headaches than did the handball players. The between-group comparison found significant differences in all outcome measures (P<.05), except in the tibialis anterior muscle pressure pain threshold on the dominant (P=.958) and the nondominant (P=.453) sides. CONCLUSIONS: Professional male boxers seem to suffer a greater headache impact and local sensitization of the craniomandibular region than do professional handball players. It cannot be determined whether these findings are short-lasting, as a result of the training activity, or long-lasting.

Tumor de la estroma gastrointestinal familiar por mutación en el exón 13 (K642E) del gen KIT / Familial gastrointestinal stroma tumor due to mutation in exon 13 (K642E) of the KIT gene

No disponible

[Medical reflections on a case of pulmonary thromboembolism in pregnancy]. / Reflexiones médicas a propósito de un caso de tromboembolia pulmonar en el embarazo.

Maternal mortality is still high in the world. Pulmonary thromboembolism as a cause of death is the second in developed countries. The frequency of reported events in Latin-American is 0.6%, which contrasts with that reported for developed countries (14.9%). This difference may be related to information bias. A review of the current information about this topic is presented, and we report a short case of a pregnant woman who presented pulmonary thromboembolism event at 30 weeks of pregnancy. Appropriate therapy allowed maternal and fetal survival.

Reflexiones médicas a propósito de un caso de tromboembolia pulmonar en el embarazo / Medical reflections on a case of pulmonary thromboembolism in pregnancy

La mortalidad materna en el mundo es aún alta. La tromboembolia pulmonar como causa de muerte ocupa el segundo lugar en países desarrollados. En Latinoamérica, la frecuencia informada es de 0.6%, lo cual contrasta con la señalada para países desarrollados (14.9%). Esta diferencia puede estar relacionada a sesgos de información. Por tal motivo se revisó la información actual del tema y presentamos un breve caso clínico de una mujer quien presentó evento de tromboembolia pulmonar en la semana 30 del embarazo; el manejo adecuado de la misma, permitió la supervivencia materna y fetal.

Maternal mortality is still high in the world. Pulmonary thromboembolism as a cause of death is the second in developed countries. The frequency of reported events in Latin-American is 0.6%, which contrasts with that reported for developed countries (14.9%). This difference may be related to information bias. A review of the current information about this topic is presented, and we report a short case of a pregnant woman who presented pulmonary thromboembolism event at 30 weeks of pregnancy. Appropriate therapy allowed maternal and fetal survival.

Concordancia en el diagnóstico de Dolor Torácico entre urgencias de Atención Primaria y Especializada / The agreement in the diagnosis of the thoracic pain in a service of urgencies in Primary Care and the Hospital

Objetivo. Analizar la concordancia en el diagnóstico y actuación clínica en los casos de dolor torácicoatendidos en un servicio de urgencias extrahospitalarias, derivados al Hospital de referencia.Metodología. Estudio descriptivo de los pacientes atendidos por dolor torácico en la unidad de urgenciasextrahospitalarias de Campoo y derivados al Hospital Sierrallana durante el año 2002, comparandola asistencia clínica y el diagnóstico realizados en cada nivel. Análisis estadístico: para variablescuantitativas se utilizó la media y porcentajes para las cualitativas, chi-cuadrado para comparar variablescualitativas y t-Student para comparar medias; el índice Kappa para analizar la concordanciaentre los diagnósticos.Resultados. Se atendieron 52 casos, con una edad media de 67,3 años y ligero predominio masculino.El índice Kappa en el diagnostico de dolor torácico entre los dos niveles (urgencias-hospital) fuede 0,231 para el angor y de 0,866 para el IAM. Al 91.4% de los pacientes derivados se les realizó anivel hospitalario alguna prueba o interconsulta no accesible a nivel de atención primaria. Ingresó el38.5 % de los pacientes derivados.Conclusiones. Existe una baja concordancia entre niveles en el diagnostico de angor y muy buenoen el de IAM. La derivación puede considerarse correcta en la mayoría de los casos. No se realizael ECG a la totalidad de los pacientes. Las diferencias de concordancia se debieron en su mayoríaa dolores torácicos atípicos. A nivel hospitalario se cumplimentan mejor los volantes de derivación yse administra más medicación. A nivel de Atención Primaria hay mayor registro de tensión arterial ypulso arterial

Objective. To analyze the agreement in the diagnosis and clinical performance of the cases of thoracicpain in a service of extrahospitable urgencies and derivates to the reference Hospital.Methodology. Cross-sectional study of the patients with thoracic pain attended in the extrahospitableurgencies service of Campoo and derivatives to Sierrallana Hospital during the year 2002, it comparingthe clinical attendance and diagnosis made in each level. Statistical analysis: quantitative variableshave been used the mean and percentage for the qualitative ones, chi-square has been used tocompare qualitative variables and t-student has been used to compare averages; Kappa index havebeen used to analyze the agreement between the diagnoses.Results. 52 cases were attended, with an average age of 67.3 years and mainly masculine sex. TheKappa index of agreement of diagnoses between both levels (urgency-hospital) was 0.231 for angorand 0,866 for cardiac infarction. In the 91.4% of the patients in the hospital was done any non accessibletest at level of primary care. The 38.5% of the derived patients was ingresed.Conclusions. It exists a low agreement between levels in the diagnosis of angor and very good in cardiacinfarction, probably it is motivated by the doubt of the physician. The derivation can be consideredcorrect. It is important the non accomplishment of the ECG in the totality of the patients. The differencein the agreement is mainly by atypical thoracic pains. The medical inform is better complimented in thehospital but the arterial tension and arterial pulse is better at the level of Primary Care

In silico studies using Radial Distribution Function approach for predicting affinity of 1 alpha,25-dihydroxyvitamin D(3) analogues for Vitamin D receptor.

The Radial Distribution Function (RDF) approach has been applied to the study of the chick intestinal VDR affinity of 49 Vitamin D analogues. A model able to describe more than 77.5% of the variance in the experimental activity was developed with the use of the mentioned approach. In contrast, none of four different approaches, including the use of Topological, BCUT, Randic molecular profiles and Geometrical descriptors were able to explain more than 55% of the variance in the mentioned property, with the same number of variables in the equation.

[Incidence and clinical features of patients with comorbidity attended in internal medicine areas]. / Incidencia y características clínicas de los pacientes con pluripatología ingresados en una unidad de medicina interna.

BACKGROUND AND OBJECTIVE: Our objective was to assess the incidence and clinical features of patients with numerous disorders--comorbidity patients (CP)--and to clinically validate the CP criteria defined by a panel of experts (patients with 2 or more chronic diseases, distributed into seven categories). PATIENTS AND METHOD: Prospective observational study of all patients, attended in internal medicine areas of a tertiary teaching hospital, during June 2003. Patients were stratified in 3 cohorts: CP, palliative, and general (GE). Incidence of CP, functional evaluation (at baseline, at admission, and at discharge), and burden of hospital care (by means of urgent and programmed visits, as well as episodes of hospitalization) in the last 12 months were analyzed. A multivariate analysis of predictors of survival and functional deterioration (fall in Barthel's scale > or = 10 points between baseline-discharge values) was performed in the CP cohort. RESULTS: 339 patients (CP cohort: 132; palliative: 52; GE: 155) were included. The overall incidence was 38.9/100 admissions/month. CP were older (75 [11] vs 67 [16]); had higher mortality (19.3% vs 6.1%; relative risk [RR]: 3.66 [95% confidence interval [CI], 1.65-8.13]; lower functional ability at baseline (45 vs 95), at admission (20 vs 75), and at discharge (20 vs 95); higher rates of significant functional deterioration (16% vs 7%; RR = 2.47 [95% CI, 1.15-5.35]); and required more burden of hospital care by means of urgent care (3.6 [3.4] episodes vs 2.4 [1.9]), and hospitalizations (1.9 [1.3] vs 1.5 [1]) than GE patients. Chronic digestive/hepatic diseases (odds ratio [OR] = 48.3 [2.4-980.9], peripheric vascular disease/diabetes with visceral involvement (OR = 5.6 [CI 95%, 1.1-28.6]), and better functional ability at admission were associated with survival. Female gender (OR ) 46.6 [CI 95%, 4.5-486.9]), chronic lung disease (OR = 8.9 [CI 95%, 1.2-64]), and neurologic disease with disability (OR = 8 [CI 95%, 1.1-58.9]), were associated with significant functional deterioration during hospital stay. CONCLUSIONS: The defined CP criteria were highly accurate in detecting a population of patients with high attention in Internal Medicine areas, high mortality rates, clinical frailty (more need of hospital care), and significant functional deterioration. Barthel's scale identified correctly this group of patients, and was independently associated with survival.

Incidencia y características clínicas de los pacientes con pluripatología ingresados en una unidad de medicina interna / Incidence and clinical features of patients with comorbidity attended in internal medicine areas

Fundamento y objetivo: Analizar la incidencia y características clínicas y evolutivas de pacientes con pluripatología (PP), según la definición propuesta por una comisión de expertos (2 o más enfermedades crónicas distribuidas en 7 categorías). Pacientes y método: Estudio prospectivo observacional en áreas de medicina interna de un hospital de tercer nivel durante junio de 2003. Se estratificó a los pacientes en PP, paliativo (PL) y general (GE) según los criterios de una comisión de expertos. Se analizó la incidencia de PP, procedencia, limitación funcional basal, al ingreso y al alta, evolución y consumo de recursos (atenciones urgentes, programadas, y hospitalizaciones) en los 12 meses previos. Se realizó un análisis multivariante de los factores asociados a la supervivencia y al deterioro funcional significativo (descenso en la escala de Barthel de 10 o más puntos entre basal-alta) en la cohorte de PP. Resultados: Se incluyó a 339 pacientes (cohorte PP: 132; PL: 52; GE: 155). La incidencia global de PP fue 38,9/100 ingresos/mes. En comparación con la cohorte GE, los PP tuvieron mayor edad (media [desviación estándar] 75 [11] frente a 67 [16] años); mayor mortalidad (un 19,3 frente al 6,1%; riesgo relativo [RR] = 3,66; [intervalo de confianza [IC] del 95%, 1,65-8,13]); mayor limitación funcional basal (45 frente a 95), al ingreso (20 frente as 75) y al alta (20 frente a 95); mayor porcentaje de deterioro funcional significativo (un 16 frente al 7%; RR = 2,47 [IC del 95%, 1,15-5,35]); y mayor consumo de recursos en términos de asistencia urgente (3,6 [3,4] episodios frente a 2,4 [1,9]) y hospitalizaciones (1,9 [1,3] frente a 1,5 [1]). La supervivencia se asoció con padecer enfermedad del aparato digestivo (odds ratio [OR] = 48,3 [IC del 95%, 2,4-980,9]) o arteriopatía periférica/diabetes con repercusión visceral (OR = 5,6 [IC del 95%, 1,1-28,6]) y una mayor puntuación Barthel al ingreso. Se asociaron a un deterioro funcional significativo el sexo femenino (OR = 46,6 [IC del 95%, 4,5-486,9]) y padecer enfermedad pulmonar crónica (OR = 8,9 [IC del 95%, 1,2-64]) o enfermedad neurológica con discapacidad (OR = 8 [IC del 95%, 1,1-58,9]). Conclusiones: En áreas de medicina interna la incidencia de PP es elevada. La definición propuesta identifica a una población con especial fragilidad clínica, con una mayor necesidad de recursos hospitalarios y un deterioro funcional importante. La escala de Barthel constituyó un buen identificador común de grupo y un marcador pronóstico independiente

Background and objective: Our objective was to assess the incidence and clinical features of patients with numerous disorders--comorbidity patients (CP)--and to clinically validate the CP criteria defined by a panel of experts (patients with 2 or more chronic diseases, distributed into seven cathegories). Patients and method: Prospective observational study of all patients, attended in internal medicine areas of a tertiary teaching hospital, during June 2003. Patients were stratified in 3 cohorts: CP, palliative, and general (GE). Incidence of CP, functional evaluation (at baseline, at admission, and at discharge), and burden of hospital care (by means of urgent and programmed visits, as well as episodes of hospitalization) in the last 12 months were analyzed. A multivariate analysis of predictors of survival and functional deterioration (fall in Barthel's scale >= 10 points between baseline-discharge values) was performed in the CP cohort. Results: 339 patients (CP cohort: 132; palliative: 52; GE: 155) were included. The overall incidence was 38.9/100 admissions/month. CP were older (75 [11] vs 67 [16]); had higher mortality (19.3% vs 6.1%; relative risk [RR]: 3.66 [95% confidence interval [CI], 1.65-8.13]; lower functional ability at baseline (45 vs 95), at admission (20 vs 75), and at discharge (20 vs 95); higher rates of significant functional deterioration (16% vs 7%; RR = 2.47 [95% CI, 1.15-5.35]); and required more burden of hospital care by means of urgent care (3.6 [3.4] episodes vs 2.4 [1.9]), and hospitalizations (1.9 [1.3] vs 1.5 [1]) than GE patients. Chronic digestive/hepatic diseases (odds ratio [OR] = 48.3 [2.4-980.9], peripheric vascular disease/diabetes with visceral involvement (OR = 5.6 [CI 95%, 1.1-28.6]), and better functional ability at admission were associated with survival. Female gender (OR ) 46.6 [CI 95%, 4.5-486.9]), chronic lung disease (OR = 8.9 [CI 95%, 1.2-64]), and neurologic disease with disability (OR = 8 [CI 95%, 1.1-58.9]), were associated with significant functional deterioration during hospital stay. Conclusions: The defined CP criteria were highly accurate in detecting a population of patients with high attention in Internal Medicine areas, high mortality rates, clinical frailty (more need of hospital care), and significant functional deterioration. Barthel's scale identified correctly this group of patients, and was independently associated with survival

Diagnóstico tardío en la roturatraumática del páncreas y el conductopancreático / Delayed diagnosis in the traumatic disruption of pancreatic duct

No disponible

Metapsicologia da histeria no "projeto para uma psicologia de Freud: uma descoberta ainda atual para a pratica clinica

Apos uma breve apresentacao da histeria (psiconeurose de defesa), no contexto historico da primeira decada da psicanalise, o autor - numa primeira parte do seu trabalho - apresenta o referencial teorico do 'Projeto', que ele considera como uma sistematizacao primordial, anterior as duas conhecidas topicas. Descreve o desenvolvimento de psy e da memoria, os tres modelos funcionais do aparelho mental phi-psy-omega e a formacao do ego e do pensar. Na segunda parte do trabalho, aborda a clinica da histeria nesse referencial, que exige uma distincao fundamental entre Funcoes Primaria e Secundaria e, nesta ultima, entre Processos Primario e Secundario, que atravessa todo o desenvolvimento mental, o que e apresentado com base no caso clinico Emma, de Freud. O tema da histeria e conduzido ao longo do trabalho ate o seu significado fundante da vida mental.

Metapsicologia da histeria no "Projeto para uma psicologia" de Freud: uma descoberta ainda atual para a prática clínica / Metapsychology of hysteria in Freud's project for a psychology: a very up-to-date discovery for clinical practice

Após uma breve apresentação da histeria (psiconeurose de defesa),no contexto histórico da primeira década da psicanálise, o autor - numa primeira parte do seu trabalho - apresenta o referencial teórico do "Projeto", que ele considera como uma sistematização primordial, anterior às duas conhecidas tópicas. Descreve o desenvolvimento de psy e da memória, os três modelos funcionais do aparelho mental phi-psy-ômega e a formação do ego e do pensar. Na segunda parte do trabalho, aborda a clínica da histeria nesse referencial, que exige uma distinção fundamental entre Funções Primária e Secundária e, nesta última, entre Processos Primário e Secundário, que atravessa todo o desenvolvimento mental, o que é apresentado com base no caso clínico Emma, de Freud. O tema da histeria é conduzido ao longo do trabalho até o seu significado fundante da vida mental

Sobre a palavra-conceito "conhecimento" para uso clinico

O autor analisa a palavra-conceito conhecimento a partir da sua etimologia greco-latina, evidenciando o seu sentido comunitario ou afetivo, gerativo e noetico. Esse termo e ainda elucidado atraves da analise de outro termo que lhe e correlativo e diferenciado, a alucinacao, como algo noetico, nao gerado da experiencia e com alguem. Trata-se em ambos os casos, de um entendimento (genero) especificamente oposto no conhecimento (co-g-nose) e na alucinacao ou alucinose (hallos-g-nose). Todo conhecimento humano e misterioso.

Sobre a palavra-conceito "conhecimento"para uso clínico / On the clinical use of the concept \"Knowledge\"

O autor analisa a palavra-conceito conhecimento a partir da sua etimologia greco-latina, evidenciando o seu sentido comunitário ou afetivo, gerativo e noético. Esse termo é ainda elucidado através da análise de outro termo que lhe é correlativo e diferenciado, a alucinação, como algo noético, não gerado da experiência e com alguém. Trata-se em ambos os casos, de um entendimento (gênero) especificamente oposto no conhecimento (co-g-nose) e na alucinação ou alucinose (hállos-g-nose). Todo conhecimento humano é misterioso(au)