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Case Report
Successful treatment for serious depression with suicidal risk in a heart transplant patient
Tratamiento Exitoso para la Depresión Grave con Riesgo Suicida en un Paciente Trasplantado de Corazón
María del Mar Arango-Posada, Ana Isabel Prada-Escobar, Carolina Marín-Hernández, Veronica Monsalve-Franco, Diana Restrepo-Bernal
Corresponding author
dianarestrepobernal@gmail.com

Corresponding author.
Facultad de Medicina, Universidad CES, Medellín, Colombia
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    "textoCompleto" => "<span class="elsevierStyleSections"><span id="sec0005" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0065">Introduction</span><p id="par0005" class="elsevierStylePara elsevierViewall">Transplant patients have a higher prevalence of depression than the general population&#46;<a class="elsevierStyleCrossRef" href="#bib0005"><span class="elsevierStyleSup">1</span></a> While in the general population the prevalence is 3&#37;&#8211;10&#37;&#44;<a class="elsevierStyleCrossRef" href="#bib0010"><span class="elsevierStyleSup">2</span></a> in organ recipients it is 14&#37;&#8211;63&#37;&#46;<a class="elsevierStyleCrossRef" href="#bib0015"><span class="elsevierStyleSup">3</span></a> Depression has the potential to decrease the overall success after transplantation&#44; and leads to a significant increase in morbidity and mortality&#46; According to the meta-analysis by Dew et al&#46;&#44;<a class="elsevierStyleCrossRef" href="#bib0005"><span class="elsevierStyleSup">1</span></a> depression is associated with a 65&#37; higher risk of graft rejection and post-transplant mortality&#46; Patients with depression have greater social isolation<a class="elsevierStyleCrossRefs" href="#bib0020"><span class="elsevierStyleSup">4&#44;5</span></a> and poorer adherence to diet&#44; physical rehabilitation<a class="elsevierStyleCrossRefs" href="#bib0030"><span class="elsevierStyleSup">6&#44;7</span></a> and the immunosuppressive medication regimen required post-transplant&#46;<a class="elsevierStyleCrossRef" href="#bib0040"><span class="elsevierStyleSup">8</span></a> Depression has also been associated with high concentrations of <span class="elsevierStyleSmallCaps">C-</span>reactive protein and proinflammatory cytokines&#44; each of which increases the risk of death in the general population and in cohorts of patients with end-stage organ disease&#46;<a class="elsevierStyleCrossRefs" href="#bib0045"><span class="elsevierStyleSup">9&#44;10</span></a></p><p id="par0010" class="elsevierStylePara elsevierViewall">Available oral antidepressant treatments have two main limitations&#44; delay in onset of action and undesirable effects&#46;<a class="elsevierStyleCrossRefs" href="#bib0055"><span class="elsevierStyleSup">11&#44;12</span></a> However&#44; there is now a drug treatment which has been proven to rapidly reduce suicidal ideation and severe depressive symptoms&#46;<a class="elsevierStyleCrossRef" href="#bib0065"><span class="elsevierStyleSup">13</span></a> Ketamine&#44; an N-methyl-D-aspartate receptor antagonist&#44; has evidence from 10 systematic reviews and clinical trials that conclude it significantly reduces severe symptoms of depression and suicidal ideation in a matter of hours or a few days&#46;<a class="elsevierStyleCrossRefs" href="#bib0070"><span class="elsevierStyleSup">14&#44;15</span></a></p><p id="par0015" class="elsevierStylePara elsevierViewall">Ketamine has been shown to be an effective option for treating suicidal ideation and major depression in patients in hospital or Accident and Emergency department settings&#46;<a class="elsevierStyleCrossRefs" href="#bib0070"><span class="elsevierStyleSup">14&#44;16</span></a> However&#44; despite multiple studies indicating that ketamine is effective for treating severe depressive episodes&#44;<a class="elsevierStyleCrossRefs" href="#bib0070"><span class="elsevierStyleSup">14&#44;15</span></a> there is no reported experience and there are no clinical practice guidelines for prescribing it in the context of post-transplant patients&#46; This study presents a case report of a patient with severe depression and suicidal ideation who was administered ketamine by intravenous infusion&#46;</p></span><span id="sec0010" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0070">Case report</span><p id="par0020" class="elsevierStylePara elsevierViewall">This was a 55-year-old married man&#44; who lives with his wife and children&#46; He was retired due to heart disease&#44; having worked in the financial sector&#46; <a class="elsevierStyleCrossRef" href="#fig0005">Fig&#46; 1</a> shows the timeline&#46;</p><elsevierMultimedia ident="fig0005"></elsevierMultimedia><span id="sec0015" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0075">Previous medical history</span><p id="par0025" class="elsevierStylePara elsevierViewall">Heart transplant six months earlier&#44; due to heart failure of ischaemic origin&#46; He was admitted to the Accident and Emergency department due to orthopnoea and fatigue&#46; After being medically assessed&#44; he was diagnosed with subacute right infrapopliteal deep vein thrombosis and acute bilateral lobar and segmental pulmonary embolism&#44; predominantly affecting the right&#46; Before the transplant&#44; he had a history of systemic hypertension&#44; dyslipidaemia and type 2 diabetes mellitus&#44; and had suffered a stroke resulting in mild right hemiparesis&#46;</p></span><span id="sec0020" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0080">Diagnostic aids</span><p id="par0030" class="elsevierStylePara elsevierViewall">Transthoracic cardiac ultrasound showed myocardial contractility with diffuse hypokinesis and remodelling of the basal segment of the inferior wall&#44; with an ejection fraction of 38&#37;&#46; Myocardial biopsy ruled out acute cellular rejection of the graft&#46; Electrocardiogram revealed sinus tachycardia&#44; right bundle branch block&#44; and altered repolarisation in V<span class="elsevierStyleInf">1</span>&#46;</p></span><span id="sec0025" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0085">Laboratory tests</span><p id="par0035" class="elsevierStylePara elsevierViewall">D-dimer and troponins were elevated&#46; Blood count&#44; kidney function&#44; liver tests&#44; electrolytes&#44; thyrotropin&#44; Vitamin B<span class="elsevierStyleInf">12</span> and folic acid were normal&#59; serology for human immunodeficiency virus and syphilis were negative&#46;</p></span><span id="sec0030" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0090">Psychiatric interview</span><p id="par0040" class="elsevierStylePara elsevierViewall">While in the Accident and Emergency department&#44; he was assessed through an unstructured psychiatric interview&#46; Depressive and suicidal ideas were identified&#44; and so he was referred for Psychiatric assessment&#46; The assessment by Liaison Psychiatry identified a six-month history of depressive symptoms&#44; characterised by sadness for most of the day every day&#44; anhedonia&#44; overall insomnia&#44; decreased appetite with unquantified weight loss&#44; irritability&#44; easy crying&#44; memory problems and depressive and suicidal ideas&#46; He was also markedly sedentary and anergic&#44; resulting in him spending most of the day and night in bed when he was having symptoms&#46;</p></span><span id="sec0035" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0095">Psychiatric history</span><p id="par0045" class="elsevierStylePara elsevierViewall">He had no history of depression or suicidal behaviour&#44; either personal or family&#44; or psychotic symptoms or disorders&#46; No previous substance abuse&#46; In terms of personality traits&#44; he was described by his wife as an extroverted&#44; cheerful person who had always been effective at resolving problems and difficulties&#46;</p></span><span id="sec0040" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0100">Mental examination</span><p id="par0050" class="elsevierStylePara elsevierViewall">Alert&#44; orientated overall&#44; establishing eye contact&#44; appropriate attention&#44; no motor restlessness&#44; depressive affect&#44; fluent and well-articulated language&#44; with a quiet tone of voice and normal language processing&#46; His thinking was coherent and logical&#44; with depressive cognitions of disability and hopelessness&#44; thinking about death and suicidal ideation&#44; without delusions&#46; He denied sensory-perceptive disorders and had his memory intact&#44; appropriate judgement but negative prospection&#46; On admission to hospital&#44; his score on the PHQ-9 scale was 20 and on the MoCA&#44; 28&#46; Physiotherapy and assessment by a hospital nutritionist and neurologist were ordered&#46;</p></span><span id="sec0045" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0105">Hospital follow-up</span><p id="par0055" class="elsevierStylePara elsevierViewall">The major depression in this patient met severity criteria &#40;sedentary lifestyle that led to deep vein thrombosis and pulmonary embolism&#44; in addition to suicidal ideation and high risk of graft loss&#41;&#44; so it was decided to start mirtazapine&#44; which&#44; in addition to treating his depression&#44; could help with insomnia and hyporexia&#46; Eight days after starting mirtazapine&#44; while still within the therapeutic window before the onset of the full action of the antidepressant&#44; the patient was discussed at a case conference with the transplant cardiologists&#46; At the meeting&#44; the benefits and risks of ketamine were presented to the medical group&#44; with a proposal to administer it to the patient&#44; which was approved&#46; The reasons for deciding on this option for the patient were the persistence of suicidal risk&#44; the rapid onset of the antidepressant action of ketamine compared to antidepressants&#44; and the ease of application and monitoring of the patient as he was already in a hospital environment&#46;</p></span><span id="sec0050" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0110">Pre-procedure assessment for appropriate ketamine administration</span><p id="par0060" class="elsevierStylePara elsevierViewall">In 2017 Sanacora et al&#46;<a class="elsevierStyleCrossRef" href="#bib0085"><span class="elsevierStyleSup">17</span></a> published a consensus document on ketamine for the treatment of affective disorders&#44; which includes seven recommendations for the assessment of the candidate before infusion of the drug&#46; <a class="elsevierStyleCrossRef" href="#tbl0005">Table 1</a> shows the assessment carried out on the patient&#46;</p><elsevierMultimedia ident="tbl0005"></elsevierMultimedia></span><span id="sec0055" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0115">Anaesthetics</span><p id="par0065" class="elsevierStylePara elsevierViewall">Liaison Psychiatry made a referral to the Anaesthetics department to request support in the infusion of ketamine to a patient recently having had a heart transplant&#46; Working together&#44; we found systematic reviews and meta-analyses which enabled us to identify various doses of ketamine administration &#40;from 0&#46;5 to 7&#46;0&#8239;mg&#47;kg&#41; and infusion frequencies &#40;single&#44; 1&#8211;3 times per week&#44; once a month&#41;&#46;<a class="elsevierStyleCrossRefs" href="#bib0090"><span class="elsevierStyleSup">18&#44;19</span></a> In other clinical settings&#44; continuous ketamine drips are common&#44; such as in intensive care for sedation&#47;analgesia&#44;<a class="elsevierStyleCrossRef" href="#bib0100"><span class="elsevierStyleSup">20</span></a> on hospital wards to treat acute<a class="elsevierStyleCrossRef" href="#bib0105"><span class="elsevierStyleSup">21</span></a> and chronic pain&#44;<a class="elsevierStyleCrossRef" href="#bib0110"><span class="elsevierStyleSup">22</span></a> and in Accident and Emergency departments for pain and as an alternative to opioids&#46;<a class="elsevierStyleCrossRef" href="#bib0115"><span class="elsevierStyleSup">23</span></a></p><p id="par0070" class="elsevierStylePara elsevierViewall">In a recent systematic review and meta-analysis<a class="elsevierStyleCrossRef" href="#bib0120"><span class="elsevierStyleSup">24</span></a> which included 28 studies in the systematic review and 19 in the meta-analysis&#44; nine studies were identified that assessed the effects of multiple infusions of 0&#46;5&#8239;mg&#47;kg of ketamine in 269 participants&#46; No studies with continuous ketamine infusion were identified&#46; According to the consensus for the use of ketamine in affective disorders&#44;<a class="elsevierStyleCrossRef" href="#bib0085"><span class="elsevierStyleSup">17</span></a> the most frequently administered antidepressant dose in clinical studies with ketamine is 0&#46;5&#8239;mg&#47;kg in venous infusion over 40&#8239;min&#44;<a class="elsevierStyleCrossRef" href="#bib0125"><span class="elsevierStyleSup">25</span></a> which does not produce anaesthetic effects&#46; However&#44; an average increase of 13&#46;4 mmHg<a class="elsevierStyleCrossRef" href="#bib0045"><span class="elsevierStyleSup">9</span></a> in systolic pressure has been reported&#44; with BP values of 180&#47;100&#8239;mmHg or heart rates &#62;110&#8239;bpm in 30&#37; of treated patients&#46;</p><p id="par0075" class="elsevierStylePara elsevierViewall">The use of ketamine infusion for depression has been associated with the following side effects<a class="elsevierStyleCrossRefs" href="#bib0130"><span class="elsevierStyleSup">26&#44;27</span></a>&#58; psychiatric in 72&#37; of studies assessing it &#40;anxiety&#44; agitation&#44; irritability&#44; delusions&#44; panic&#44; derealisation&#44; depersonalisation&#41;&#59; cardiovascular in 38&#37; &#40;increased blood pressure&#44; arrhythmias&#44; palpitations&#44; chest pain&#44; increased heart rate&#41;&#59; neurological &#40;headache&#44; dizziness&#44; poor motor coordination&#44; tremor and involuntary movements&#41;&#59; and in other systems &#40;gastrointestinal&#44; respiratory&#44; urological&#44; ocular&#41;&#46; Consequently&#44; in addition to the particular situation of our patient &#40;heart transplant&#41; and the fact that we were unable to find any reported cases in similar patients&#44; the Anaesthetics department proposed a total dose of 90&#8239;mg of ketamine diluted in 250&#8239;ml of 0&#46;9&#37; saline solution to infuse over 25&#8239;h at a rate of 10&#8239;ml&#47;h&#44; which provided ketamine 1&#46;5&#8239;mg&#47;kg body weight&#46; This method of infusing ketamine was chosen to extend the infusion time and reduce the potential dissociative and cardiovascular symptoms reported with high doses of the drug&#46;<a class="elsevierStyleCrossRef" href="#bib0140"><span class="elsevierStyleSup">28</span></a></p></span><span id="sec0060" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0120">Procedure</span><p id="par0080" class="elsevierStylePara elsevierViewall">The day before the ketamine infusion&#44; they spoke with the patient and his wife&#59; his clinical situation was explained from a psychiatric perspective&#44; along with the option of administering ketamine to treat his depression&#46; On the day of the ketamine infusion&#44; just beforehand&#44; a conversation was held with the patient and his wife about the previous day&#39;s conversation&#46; The patient&#39;s understanding of the clinical situation was verified&#44; doubts were resolved&#44; and informed consent was signed&#46; The patient&#39;s weight and height were checked &#40;60&#8239;kg and 170&#8239;cm&#59; body mass index&#44; 20&#46;7&#41;&#46; The patient&#39;s vital signs were taken and he was asked to lie down on the bed&#46; The ketamine infusion was administered through a venous catheter in his left forearm&#46; His initial blood pressure was 130&#47;85&#8239;mmHg&#59; heart rate&#44; 72&#8239;bpm&#59; respiratory rate&#44; 14&#8239;rpm&#59; and temperature&#44; 36&#46;5&#176;C&#46; Continuous blood pressure monitoring showed a maximum of 155&#47;92&#8239;mmHg and a minimum of 105&#47;82&#8239;mmHg&#44; with a maximum heart rate of 90&#8239;bpm and a minimum of 69&#8239;bpm&#46;</p></span><span id="sec0065" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0125">Side effects</span><p id="par0085" class="elsevierStylePara elsevierViewall">The patient did not report any side effects during the ketamine infusion&#44; which his wife corroborated&#44; as she had been with him the entire time&#46;</p></span><span id="sec0070" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0130">Interview and mental examination after ketamine infusion</span><p id="par0090" class="elsevierStylePara elsevierViewall">The day after the ketamine infusion&#44; the patient reported increased appetite and better mood&#46; He said the suicidal thoughts had almost completely disappeared and he had slept better&#46; Two days after receiving the infusion&#44; the patient reported feeling &#8220;very well&#8221;&#44; with no sadness&#44; with a perception of well-being and optimism&#44; without negative thoughts about himself&#44; and with a desire to live and share with his family&#46; His wife said she saw him in very good spirits&#44; smiling&#44; with spontaneous displays of affection towards her and the children&#44; spontaneously talking about returning home and showing affection through hugs and kisses to his family members&#46;</p></span><span id="sec0075" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0135">Changes in the PHQ-9 score after the infusion</span><p id="par0095" class="elsevierStylePara elsevierViewall">The PHQ-9 prior to ketamine infusion was 20&#46; The next day&#44; when the infusion was stopped&#44; the PHQ-9 was 13&#59; the day after the score was 2&#46; The initial changes in the score were found in the desire to die&#44; sadness and anhedonia&#44; and 48&#8239;h later&#44; the almost complete disappearance of depressive symptoms&#46;</p></span><span id="sec0080" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0140">Hospital discharge</span><p id="par0100" class="elsevierStylePara elsevierViewall">The patient was discharged four days after completing the ketamine infusion&#46; He reported a complete improvement in his depressive symptoms&#46; His wife described him as fully recovered from the depression&#46; She said she saw him &#8220;full of energy&#44; without negative or hopeless thoughts&#44; optimistic about the future and with plans to do repairs at home&#8221;&#46;</p></span><span id="sec0085" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0145">Outpatient follow-up</span><p id="par0105" class="elsevierStylePara elsevierViewall">Due to the health restrictions imposed by the SARS-COV-2 pandemic&#44; the patient received psychiatric follow-up by telephone&#46; The psychiatry resident &#40;MMA&#41; called him every eight days to conduct the hospital follow-up&#46; The telephone interview was semi-structured&#46; First&#44; the patient was asked about personal and family events during the last week&#44; and then a check was made on mood and associated cognitive functions&#46; He was then asked to complete the PHQ-9 and send it in via his mobile phone&#46; The patient continues to take mirtazapine 30&#8239;mg orally every night&#46;</p><p id="par0110" class="elsevierStylePara elsevierViewall">His wife reported by telephone that her husband continues to be in good spirits&#44; is more physically active&#44; does household activities&#44; is in a better mood&#44; makes jokes&#44; starts conversations spontaneously&#44; sleeps well&#44; has a better appetite&#44; and is making plans for the future&#46; The follow-up continued in this form for the next 12 weeks&#44; with affective stability and persistence of euthymia observed&#46; Eleven months after the ketamine infusion&#44; the patient continues on treatment with mirtazapine 30&#8239;mg&#47;night&#46; He says he feels in good spirits&#44; able to enjoy his daily activities and without suicidal thoughts&#46; His wife and children see him in better spirits and with more physically active during the day&#46; The transplant cardiologist describes an overall clinical improvement&#44; including improvement in mood&#46;</p></span></span><span id="sec0090" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0150">Discussion</span><p id="par0115" class="elsevierStylePara elsevierViewall">The admission of a patient with deep vein thrombosis and pulmonary embolism&#44; which subsequently generated cardiac hypokinesis and put the patient&#39;s life at risk&#44; was the indirect consequence of symptoms such as sadness&#44; anhedonia&#44; anergy and a sedentary lifestyle in a heart transplant patient with comorbid severe depression&#46;</p><p id="par0120" class="elsevierStylePara elsevierViewall">In transplant patients&#44; major depression doubles the risk of graft rejection and post-transplant mortality&#44;<a class="elsevierStyleCrossRefs" href="#bib0145"><span class="elsevierStyleSup">29&#44;30</span></a> in addition to reducing heart rate variability and contributing to the development of deep vein thrombosis&#44; as occurred in our patient&#46;<a class="elsevierStyleCrossRef" href="#bib0155"><span class="elsevierStyleSup">31</span></a> The symptoms of depression are often confused with those generated by immunosuppressive medications&#44; such as insomnia&#44; anergy&#44; difficulty concentrating and anorexia&#44; but other symptoms such as hopelessness and suicidal ideation are not considered part of the normal trajectory of the post-transplant patient&#46;<a class="elsevierStyleCrossRef" href="#bib0160"><span class="elsevierStyleSup">32</span></a></p><p id="par0125" class="elsevierStylePara elsevierViewall">Depression is a medical disorder for which there are numerous pharmacological and psychotherapeutic interventions available&#44; but most antidepressant medications take between two and six weeks to begin their therapeutic effect&#46; Therefore&#44; in the context of a patient at risk of suicide and short-term graft loss&#44; ketamine emerges as a valid therapeutic option&#46;</p><p id="par0130" class="elsevierStylePara elsevierViewall">There is increasingly more literature supporting the clinical utility of ketamine in patients with depression and other serious comorbidities&#46; This indication is based on the rapid and powerful antidepressant effect&#46; Typical dosing regimens for ketamine in these cases are sub-anaesthetic doses of 0&#46;5&#8239;mg&#47;kg in 40&#8239;min of infusion&#46; This case report is novel in two aspects&#58; first&#44; it concerns a heart transplant patient and second&#44; the dose used has not been reported before and shows a robust and positive antidepressant effect&#46;</p><p id="par0135" class="elsevierStylePara elsevierViewall">Irwin et al&#46;<a class="elsevierStyleCrossRef" href="#bib0165"><span class="elsevierStyleSup">33</span></a> reported two cases of hospice patients&#44; seriously ill with other clinical problems&#44; who had rapid and persistent improvement in depression and anxiety after ketamine infusion&#46; The patients had no adverse effects in either case&#44; and the improvement persisted for weeks&#46; In another report&#44; ketamine 0&#46;5&#8239;mg&#47;kg was infused in 60&#8239;min in a patient with metastatic prostate cancer and produced rapid improvement in depressive symptoms&#46;<a class="elsevierStyleCrossRef" href="#bib0170"><span class="elsevierStyleSup">34</span></a></p><p id="par0140" class="elsevierStylePara elsevierViewall">To the best of the authors&#39; knowledge&#44; the use of ketamine as an antidepressant has been little explored in transplant patients&#46; We hope that this report will help awaken interest and motivate the setting up of studies&#44; such as clinical trials&#44; with more structured research methodologies&#44; which would enable a better level of evidence to be obtained&#46; As far as we are aware&#44; this is the first reported case of ketamine infusion in a severely depressed heart transplant patient with suicidal ideation&#46;</p></span><span id="sec0095" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0155">Conclusions</span><p id="par0145" class="elsevierStylePara elsevierViewall">This case report shows the successful and side effect-free administration of ketamine infusion for the treatment of severe depressive symptoms and suicidal ideation in a heart transplant patient&#46;</p></span><span id="sec0100" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0160">Conflicts of interest</span><p id="par0150" class="elsevierStylePara elsevierViewall">The authors declare that they have no conflicts of interest&#46;</p></span></span>"
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    "fechaRecibido" => "2021-10-21"
    "fechaAceptado" => "2022-03-07"
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            0 => "Trasplante de coraz&#243;n"
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        "resumen" => "<span id="abst0005" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0010">Introduction</span><p id="spar0020" class="elsevierStyleSimplePara elsevierViewall">Major depressive disorder is related to unfavourable outcomes in patients with severe comorbidities&#46; In transplant patients&#44; major depression is associated with worse clinical outcomes&#46;</p></span> <span id="abst0010" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0015">Case report</span><p id="spar0025" class="elsevierStyleSimplePara elsevierViewall">We present the case of a 55-year-old man with a heart transplant due to heart failure of ischaemic origin&#46; Six months after the transplant he developed depressed mood&#44; anhedonia and suicidal ideation with a score of 20&#47;27 on the PHQ-9 depression screening scale&#46; After receiving mirtazapine 30&#8239;mg&#47;night for a week and persisting with a high suicide risk&#44; it was decided to administer ketamine infusion for 24&#8239;h&#44; with which a significant improvement in mood was observed&#44; and the disappearance of suicidal ideation 24&#8239;h after the infusion&#46;</p></span> <span id="abst0015" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0020">Discussion</span><p id="spar0030" class="elsevierStyleSimplePara elsevierViewall">Depression in transplant patients is a factor associated with graft loss and post-transplant mortality&#44; in addition to favouring other negative outcomes such as deep vein thrombosis&#46;</p></span> <span id="abst0020" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0025">Conclusions</span><p id="spar0035" class="elsevierStyleSimplePara elsevierViewall">Ketamine infusion was shown to be an effective and safe option to treat major depression with suicidal risk in a heart transplant patient&#46;</p></span>"
        "secciones" => array:4 [
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        "resumen" => "<span id="abst0025" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0035">Introducci&#243;n</span><p id="spar0040" class="elsevierStyleSimplePara elsevierViewall">El trastorno depresivo mayor se relaciona con desenlaces desfavorables en pacientes con comorbilidades graves&#46; En pacientes trasplantados&#44; la depresi&#243;n mayor se asocia con peores desenlaces cl&#237;nicos&#46;</p></span> <span id="abst0030" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0040">Reporte de caso</span><p id="spar0045" class="elsevierStyleSimplePara elsevierViewall">Se presenta el caso de un var&#243;n de 55 a&#241;os&#44; con trasplante de coraz&#243;n por insuficiencia cardiaca de origen isqu&#233;mico&#44; que 6 meses despu&#233;s del trasplante present&#243; &#225;nimo deprimido&#44; anhedonia e ideaci&#243;n suicida&#44; con un puntaje de 20 sobre 27 en la escala para tamizar depresi&#243;n PHQ-9&#46; Luego de recibir mirtazapina 30&#8239;mg&#47;noche durante 1 semana y persistir con alto riesgo suicida&#44; se decidi&#243; administrar infusi&#243;n de ketamina durante 24&#8239;h&#44; con lo cual se observ&#243; mejor&#237;a significativa en el &#225;nimo y desaparici&#243;n de la ideaci&#243;n suicida 24&#8239;h tras la infusi&#243;n&#46;</p></span> <span id="abst0035" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0045">Discusi&#243;n</span><p id="spar0050" class="elsevierStyleSimplePara elsevierViewall">La depresi&#243;n en pacientes trasplantados es un factor asociado con la p&#233;rdida del injerto y la mortalidad postrasplante&#44; adem&#225;s de favorecer otros desenlaces negativos como trombosis venosa profunda&#46;</p></span> <span id="abst0040" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0050">Conclusiones</span><p id="spar0055" class="elsevierStyleSimplePara elsevierViewall">La infusi&#243;n de ketamina se ha demostrado como una opci&#243;n efectiva y segura para tratar la depresi&#243;n mayor con riesgo suicida en un paciente trasplantado de coraz&#243;n&#46;</p></span>"
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                  \t\t\t\t">Baseline and post-infusion assessment of depressive symptoms using the depression scale &#40;PHQ-9&#41;&#44; which includes the nine depression criteria according to the DSM-IV&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">3&#46;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">History of taking psychotropic drugs&#58; the patient had never taken any antidepressant or other psychotropic drug&#46; This is the first depressive episode he has ever had in his life&#46; He has no family history of depression or other mental disorders&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">4&#46;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
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                  \t\t\t\t">Check contraindications for the use of ketamine&#58; the patient was hypertensive&#44; but blood pressure is controlled with medication&#46; He has no history of hypersensitivity to ketamine&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">5&#46;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
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                  \t\t\t\t">Clinical and laboratory screening&#58; the heart transplant staff discussed the case and it was assessed by Anaesthetics&#44; which approved the procedure&#46; Lab tests normal&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">6&#46;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
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                  \t\t\t\t">Review of the patient&#39;s medical records&#44; in addition to corroborating the history with his wife&#58; no history of allergies or previous use of opiates or benzodiazepines&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
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                  \t\t\t\t">7&#46;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
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                  \t\t\t\t">Informed consent process&#44; which included&#58; conversation about the procedure &#40;benefits&#44; risks&#44; questions&#41; the day before the ketamine infusion and the day of the infusion&#58; checking that the information had been understood&#44; resolving of doubts and written informed consent obtained&#46;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr></tbody></table>
                  """
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          "en" => "<p id="spar0010" class="elsevierStyleSimplePara elsevierViewall">Assessment for the appropriate use of ketamine infusion in the patient&#46;</p>"
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      "titulo" => "References"
      "seccion" => array:1 [
        0 => array:2 [
          "identificador" => "bibs0005"
          "bibliografiaReferencia" => array:34 [
            0 => array:3 [
              "identificador" => "bib0005"
              "etiqueta" => "1"
              "referencia" => array:1 [
                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "Depression and anxiety as risk factors for morbidity and mortality after organ transplantation&#58; a systematic review and meta-analysis"
                      "autores" => array:1 [
                        0 => array:2 [
                          "etal" => true
                          "autores" => array:6 [
                            0 => "M&#46;A&#46; Dew"
                            1 => "E&#46;M&#46; Rosenberger"
                            2 => "L&#46; Myaskovsky"
                            3 => "A&#46;F&#46; DiMartini"
                            4 => "A&#46;J&#46; DeVito Dabbs"
                            5 => "D&#46;M&#46; Posluszny"
                          ]
                        ]
                      ]
                    ]
                  ]
                  "host" => array:1 [
                    0 => array:2 [
                      "doi" => "10.1097/TP.0000000000000901"
                      "Revista" => array:6 [
                        "tituloSerie" => "Transplantation&#46;"
                        "fecha" => "2015"
                        "volumen" => "100"
                        "paginaInicial" => "988"
                        "paginaFinal" => "1003"
                        "link" => array:1 [
                          0 => array:2 [
                            "url" => "https://www.ncbi.nlm.nih.gov/pubmed/26492128"
                            "web" => "Medline"
                          ]
                        ]
                      ]
                    ]
                  ]
                ]
              ]
            ]
            1 => array:3 [
              "identificador" => "bib0010"
              "etiqueta" => "2"
              "referencia" => array:1 [
                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "The burden of mental disorders"
                      "autores" => array:1 [
                        0 => array:2 [
                          "etal" => false
                          "autores" => array:6 [
                            0 => "W&#46;W&#46; Eaton"
                            1 => "S&#46;S&#46; Martins"
                            2 => "G&#46; Nestadt"
                            3 => "O&#46;J&#46; Bienvenu"
                            4 => "D&#46; Clarke"
                            5 => "P&#46; Alexandre"
                          ]
                        ]
                      ]
                    ]
                  ]
                  "host" => array:1 [
                    0 => array:2 [
                      "doi" => "10.1093/epirev/mxn011"
                      "Revista" => array:6 [
                        "tituloSerie" => "Epidemiol Rev&#46;"
                        "fecha" => "2008"
                        "volumen" => "30"
                        "paginaInicial" => "1"
                        "paginaFinal" => "14"
                        "link" => array:1 [
                          0 => array:2 [
                            "url" => "https://www.ncbi.nlm.nih.gov/pubmed/18806255"
                            "web" => "Medline"
                          ]
                        ]
                      ]
                    ]
                  ]
                ]
              ]
            ]
            2 => array:3 [
              "identificador" => "bib0015"
              "etiqueta" => "3"
              "referencia" => array:1 [
                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "Prevalence and correlates of depression symptoms at 10 years after heart transplantation&#58; continues attention required"
                      "autores" => array:1 [
                        0 => array:2 [
                          "etal" => false
                          "autores" => array:6 [
                            0 => "F&#46; Dobbels"
                            1 => "S&#46; DeGeest"
                            2 => "S&#46; Martin"
                            3 => "J&#46; Van Cleemput"
                            4 => "W&#46; Droogne"
                            5 => "J&#46; Vanhaeke"
                          ]
                        ]
                      ]
                    ]
                  ]
                  "host" => array:1 [
                    0 => array:2 [
                      "doi" => "10.1007/s00147-004-0732-5"
                      "Revista" => array:6 [
                        "tituloSerie" => "Transpl Int&#46;"
                        "fecha" => "2004"
                        "volumen" => "17"
                        "paginaInicial" => "424"
                        "paginaFinal" => "431"
                        "link" => array:1 [
                          0 => array:2 [
                            "url" => "https://www.ncbi.nlm.nih.gov/pubmed/15338116"
                            "web" => "Medline"
                          ]
                        ]
                      ]
                    ]
                  ]
                ]
              ]
            ]
            3 => array:3 [
              "identificador" => "bib0020"
              "etiqueta" => "4"
              "referencia" => array:1 [
                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "Social isolation&#58; a predictor of mortality comparable to traditional clinical risk factors"
                      "autores" => array:1 [
                        0 => array:2 [
                          "etal" => false
                          "autores" => array:6 [
                            0 => "M&#46; Pantell"
                            1 => "D&#46; Rehkopf"
                            2 => "D&#46; Jutte"
                            3 => "S&#46;L&#46; Syme"
                            4 => "J&#46; Balmes"
                            5 => "N&#46; Adler"
                          ]
                        ]
                      ]
                    ]
                  ]
                  "host" => array:1 [
                    0 => array:2 [
                      "doi" => "10.2105/AJPH.2013.301261"
                      "Revista" => array:7 [
                        "tituloSerie" => "Am J Public Health&#46;"
                        "fecha" => "2013"
                        "volumen" => "103"
                        "paginaInicial" => "2056"
                        "paginaFinal" => "2062"
                        "link" => array:1 [
                          0 => array:2 [
                            "url" => "https://www.ncbi.nlm.nih.gov/pubmed/24028260"
                            "web" => "Medline"
                          ]
                        ]
                        "itemHostRev" => array:3 [
                          "pii" => "S0091674913017715"
                          "estado" => "S300"
                          "issn" => "00916749"
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                  ]
                ]
              ]
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            4 => array:3 [
              "identificador" => "bib0025"
              "etiqueta" => "5"
              "referencia" => array:1 [
                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "Social integration&#44; social support and mortality in the US National Health Interview Survey"
                      "autores" => array:1 [
                        0 => array:2 [
                          "etal" => false
                          "autores" => array:1 [
                            0 => "S&#46;D&#46; Barger"
                          ]
                        ]
                      ]
                    ]
                  ]
                  "host" => array:1 [
                    0 => array:2 [
                      "doi" => "10.1097/PSY.0b013e318292ad99"
                      "Revista" => array:6 [
                        "tituloSerie" => "Psychosom Med&#46;"
                        "fecha" => "2013"
                        "volumen" => "75"
                        "paginaInicial" => "510"
                        "paginaFinal" => "517"
                        "link" => array:1 [
                          0 => array:2 [
                            "url" => "https://www.ncbi.nlm.nih.gov/pubmed/23723364"
                            "web" => "Medline"
                          ]
                        ]
                      ]
                    ]
                  ]
                ]
              ]
            ]
            5 => array:3 [
              "identificador" => "bib0030"
              "etiqueta" => "6"
              "referencia" => array:1 [
                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "Association of depressive symptoms and lifestyle behaviors among Latinos at risk of type 2 diabetes"
                      "autores" => array:1 [
                        0 => array:2 [
                          "etal" => true
                          "autores" => array:6 [
                            0 => "S&#46;L&#46; Pagoto"
                            1 => "Y&#46; Ma"
                            2 => "J&#46;S&#46; Bodenlos"
                            3 => "B&#46; Olendzki"
                            4 => "M&#46;C&#46; Rosal"
                            5 => "T&#46; Tellez"
                          ]
                        ]
                      ]
                    ]
                  ]
                  "host" => array:1 [
                    0 => array:2 [
                      "doi" => "10.1016/j.jada.2009.04.010"
                      "Revista" => array:7 [
                        "tituloSerie" => "J Am Diet Assoc&#46;"
                        "fecha" => "2009"
                        "volumen" => "109"
                        "paginaInicial" => "1246"
                        "paginaFinal" => "1250"
                        "link" => array:1 [
                          0 => array:2 [
                            "url" => "https://www.ncbi.nlm.nih.gov/pubmed/19559144"
                            "web" => "Medline"
                          ]
                        ]
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                          "pii" => "S0091674918308431"
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                          "issn" => "00916749"
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                  ]
                ]
              ]
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            6 => array:3 [
              "identificador" => "bib0035"
              "etiqueta" => "7"
              "referencia" => array:1 [
                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "The association of depression and anxiety with obesity and unhealthy behaviors among community-dwelling US adults"
                      "autores" => array:1 [
                        0 => array:2 [
                          "etal" => true
                          "autores" => array:6 [
                            0 => "T&#46;W&#46; Strine"
                            1 => "A&#46;H&#46; Mokdad"
                            2 => "S&#46;R&#46; Dube"
                            3 => "L&#46;S&#46; Balluz"
                            4 => "O&#46; Gonzalez"
                            5 => "J&#46;T&#46; Berry"
                          ]
                        ]
                      ]
                    ]
                  ]
                  "host" => array:1 [
                    0 => array:1 [
                      "Revista" => array:6 [
                        "tituloSerie" => "Gen Hosp Psychiatry&#46;"
                        "fecha" => "2008"
                        "volumen" => "30"
                        "paginaInicial" => "127"
                        "paginaFinal" => "137"
                        "itemHostRev" => array:3 [
                          "pii" => "S0091674915014256"
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                          "issn" => "00916749"
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                  ]
                ]
              ]
            ]
            7 => array:3 [
              "identificador" => "bib0040"
              "etiqueta" => "8"
              "referencia" => array:1 [
                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "Patient-reported immunosuppression nonadherence 6 to 24 months after liver transplant&#58; association with pretransplant psychosocial factors and perceptions of health status change"
                      "autores" => array:1 [
                        0 => array:2 [
                          "etal" => false
                          "autores" => array:5 [
                            0 => "J&#46;R&#46; Rodrigue"
                            1 => "D&#46;R&#46; Nelson"
                            2 => "D&#46;W&#46; Hanto"
                            3 => "A&#46;I&#46; Reed"
                            4 => "M&#46;P&#46; Curry"
                          ]
                        ]
                      ]
                    ]
                  ]
                  "host" => array:1 [
                    0 => array:2 [
                      "doi" => "10.7182/pit2013501"
                      "Revista" => array:7 [
                        "tituloSerie" => "Prog Transplant&#46;"
                        "fecha" => "2013"
                        "volumen" => "23"
                        "paginaInicial" => "319"
                        "paginaFinal" => "328"
                        "link" => array:1 [
                          0 => array:2 [
                            "url" => "https://www.ncbi.nlm.nih.gov/pubmed/24311395"
                            "web" => "Medline"
                          ]
                        ]
                        "itemHostRev" => array:3 [
                          "pii" => "S0091674920303456"
                          "estado" => "S300"
                          "issn" => "00916749"
                        ]
                      ]
                    ]
                  ]
                ]
              ]
            ]
            8 => array:3 [
              "identificador" => "bib0045"
              "etiqueta" => "9"
              "referencia" => array:1 [
                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "Depression&#44; inflammation&#44; and incident cardiovascular disease in women with suspected coronary ischemia&#58; the National Heart&#44; Lung&#44; and Blood Institute-sponsored WISE Study"
                      "autores" => array:1 [
                        0 => array:2 [
                          "etal" => true
                          "autores" => array:6 [
                            0 => "V&#46; Vaccarino"
                            1 => "B&#46;D&#46; Johnson"
                            2 => "D&#46;S&#46; Sheps"
                            3 => "S&#46;E&#46; Reis"
                            4 => "S&#46;F&#46; Kelsey"
                            5 => "V&#46; Bittner"
                          ]
                        ]
                      ]
                    ]
                  ]
                  "host" => array:1 [
                    0 => array:2 [
                      "doi" => "10.1016/j.jacc.2007.07.069"
                      "Revista" => array:6 [
                        "tituloSerie" => "J Am Coll Cardiol&#46;"
                        "fecha" => "2007"
                        "volumen" => "50"
                        "paginaInicial" => "2044"
                        "paginaFinal" => "2050"
                        "link" => array:1 [
                          0 => array:2 [
                            "url" => "https://www.ncbi.nlm.nih.gov/pubmed/18021871"
                            "web" => "Medline"
                          ]
                        ]
                      ]
                    ]
                  ]
                ]
              ]
            ]
            9 => array:3 [
              "identificador" => "bib0050"
              "etiqueta" => "10"
              "referencia" => array:1 [
                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "Serum IL-6&#44; albumin and co-morbidities are closely correlated with symptoms of depression in patients on maintenance haemodialysis"
                      "autores" => array:1 [
                        0 => array:2 [
                          "etal" => true
                          "autores" => array:6 [
                            0 => "K&#46;C&#46; Hung"
                            1 => "C&#46;C&#46; Wu"
                            2 => "H&#46;S&#46; Chen"
                            3 => "W&#46;Y&#46; Ma"
                            4 => "C&#46;F&#46; Tseng"
                            5 => "L&#46;K&#46; Yang"
                          ]
                        ]
                      ]
                    ]
                  ]
                  "host" => array:1 [
                    0 => array:2 [
                      "doi" => "10.1093/ndt/gfq411"
                      "Revista" => array:6 [
                        "tituloSerie" => "Nephrol Dial Transplant&#46;"
                        "fecha" => "2011"
                        "volumen" => "26"
                        "paginaInicial" => "658"
                        "paginaFinal" => "664"
                        "link" => array:1 [
                          0 => array:2 [
                            "url" => "https://www.ncbi.nlm.nih.gov/pubmed/20631406"
                            "web" => "Medline"
                          ]
                        ]
                      ]
                    ]
                  ]
                ]
              ]
            ]
            10 => array:3 [
              "identificador" => "bib0055"
              "etiqueta" => "11"
              "referencia" => array:1 [
                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "Early trajectories of depressive symptoms after liver transplantation for alcoholic liver disease predicts long-term survival"
                      "autores" => array:1 [
                        0 => array:2 [
                          "etal" => false
                          "autores" => array:6 [
                            0 => "A&#46; DiMartini"
                            1 => "M&#46;A&#46; Dew"
                            2 => "D&#46; Chaiffetz"
                            3 => "M&#46;G&#46; Fitzgerald"
                            4 => "M&#46;E&#46; Devera"
                            5 => "P&#46; Fontes"
                          ]
                        ]
                      ]
                    ]
                  ]
                  "host" => array:1 [
                    0 => array:2 [
                      "doi" => "10.1111/j.1600-6143.2011.03496.x"
                      "Revista" => array:7 [
                        "tituloSerie" => "Am J Transplant&#46;"
                        "fecha" => "2011"
                        "volumen" => "11"
                        "paginaInicial" => "1287"
                        "paginaFinal" => "1295"
                        "link" => array:1 [
                          0 => array:2 [
                            "url" => "https://www.ncbi.nlm.nih.gov/pubmed/21645258"
                            "web" => "Medline"
                          ]
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              "identificador" => "bib0060"
              "etiqueta" => "12"
              "referencia" => array:1 [
                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "Serotonin and norepinephrine reuptake inhibitors"
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                        0 => array:2 [
                          "etal" => false
                          "autores" => array:1 [
                            0 => "R&#46;C&#46; Shelton"
                          ]
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                      ]
                    ]
                  ]
                  "host" => array:1 [
                    0 => array:2 [
                      "doi" => "10.1007/164_2018_164"
                      "Revista" => array:7 [
                        "tituloSerie" => "Handb Exp Pharmacol&#46;"
                        "fecha" => "2019"
                        "volumen" => "250"
                        "paginaInicial" => "145"
                        "paginaFinal" => "180"
                        "link" => array:1 [
                          0 => array:2 [
                            "url" => "https://www.ncbi.nlm.nih.gov/pubmed/30838456"
                            "web" => "Medline"
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                          "pii" => "S0091674913005885"
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              "identificador" => "bib0065"
              "etiqueta" => "13"
              "referencia" => array:1 [
                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "Suicide and suicidal behaviour"
                      "autores" => array:1 [
                        0 => array:2 [
                          "etal" => false
                          "autores" => array:2 [
                            0 => "G&#46; Turecki"
                            1 => "D&#46;A&#46; Brent"
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                        ]
                      ]
                    ]
                  ]
                  "host" => array:1 [
                    0 => array:2 [
                      "doi" => "10.1016/S0140-6736(15)00234-2"
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                        "tituloSerie" => "Lancet&#46;"
                        "fecha" => "2016"
                        "volumen" => "387"
                        "numero" => "10024"
                        "paginaInicial" => "1227"
                        "paginaFinal" => "1239"
                        "link" => array:1 [
                          0 => array:2 [
                            "url" => "https://www.ncbi.nlm.nih.gov/pubmed/26385066"
                            "web" => "Medline"
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            13 => array:3 [
              "identificador" => "bib0070"
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                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "Efficacy of single and repeated administration of ketamine in unipolar and bipolar depression&#58; a meta-analysis of randomized clinical trials"
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                        0 => array:2 [
                          "etal" => false
                          "autores" => array:6 [
                            0 => "J&#46; Kryst"
                            1 => "P&#46; Kawalec"
                            2 => "A&#46;M&#46; Mitoraj"
                            3 => "A&#46; Pilc"
                            4 => "W&#46; Lason"
                            5 => "T&#46; Brzostek"
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                    0 => array:2 [
                      "doi" => "10.1007/s43440-020-00097-z"
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                    0 => array:2 [
                      "titulo" => "A systematic review and meta-analysis of randomized&#44; double-blind&#44; placebo-controlled trials of ketamine in the rapid treatment of major depressive episodes"
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                        0 => array:2 [
                          "etal" => false
                          "autores" => array:6 [
                            0 => "A&#46; McGirr"
                            1 => "M&#46;T&#46; Berlim"
                            2 => "D&#46;J&#46; Bond"
                            3 => "M&#46;P&#46; Fleck"
                            4 => "L&#46;N&#46; Yatham"
                            5 => "R&#46;W&#46; Lam"
                          ]
                        ]
                      ]
                    ]
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                  "host" => array:1 [
                    0 => array:2 [
                      "doi" => "10.1017/S0033291714001603"
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                        "tituloSerie" => "Psychol Med&#46;"
                        "fecha" => "2015"
                        "volumen" => "45"
                        "paginaInicial" => "693"
                        "paginaFinal" => "704"
                        "link" => array:1 [
                          0 => array:2 [
                            "url" => "https://www.ncbi.nlm.nih.gov/pubmed/25010396"
                            "web" => "Medline"
                          ]
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                          "pii" => "S0091674920306278"
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              "identificador" => "bib0080"
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                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "Ketamine and depression&#58; a narrative review"
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                        0 => array:2 [
                          "etal" => false
                          "autores" => array:2 [
                            0 => "A&#46; Corriger"
                            1 => "G&#46; Pickering"
                          ]
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                      ]
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                  "host" => array:1 [
                    0 => array:2 [
                      "doi" => "10.2147/DDDT.S221437"
                      "Revista" => array:7 [
                        "tituloSerie" => "Drug Des Devel Ther&#46;"
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                        "volumen" => "13"
                        "paginaInicial" => "3051"
                        "paginaFinal" => "3067"
                        "link" => array:1 [
                          0 => array:2 [
                            "url" => "https://www.ncbi.nlm.nih.gov/pubmed/31695324"
                            "web" => "Medline"
                          ]
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                          "pii" => "S1081120611007812"
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                          "issn" => "10811206"
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                ]
              ]
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            16 => array:3 [
              "identificador" => "bib0085"
              "etiqueta" => "17"
              "referencia" => array:1 [
                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "A consensus statement on the use of ketamine in the treatment of mood disorders"
                      "autores" => array:1 [
                        0 => array:2 [
                          "etal" => true
                          "autores" => array:6 [
                            0 => "G&#46; Sanacora"
                            1 => "M&#46;A&#46; Frye"
                            2 => "W&#46; McDonald"
                            3 => "S&#46;J&#46; Mathew"
                            4 => "M&#46;S&#46; Turner"
                            5 => "A&#46;F&#46; Schatzberg"
                          ]
                        ]
                      ]
                    ]
                  ]
                  "host" => array:1 [
                    0 => array:2 [
                      "doi" => "10.1001/jamapsychiatry.2017.0080"
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                        "tituloSerie" => "JAMA Psychiatry&#46;"
                        "fecha" => "2017"
                        "volumen" => "74"
                        "paginaInicial" => "399"
                        "paginaFinal" => "405"
                        "link" => array:1 [
                          0 => array:2 [
                            "url" => "https://www.ncbi.nlm.nih.gov/pubmed/28249076"
                            "web" => "Medline"
                          ]
                        ]
                      ]
                    ]
                  ]
                ]
              ]
            ]
            17 => array:3 [
              "identificador" => "bib0090"
              "etiqueta" => "18"
              "referencia" => array:1 [
                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "Oral ketamine for depression&#58; a systematic review"
                      "autores" => array:1 [
                        0 => array:2 [
                          "etal" => false
                          "autores" => array:6 [
                            0 => "J&#46;D&#46; Rosenblat"
                            1 => "A&#46;F&#46; Carvalho"
                            2 => "M&#46; Li"
                            3 => "Y&#46; Lee"
                            4 => "M&#46; Subramanieapillai"
                            5 => "R&#46;S&#46; McIntyre"
                          ]
                        ]
                      ]
                    ]
                  ]
                  "host" => array:1 [
                    0 => array:1 [
                      "Revista" => array:3 [
                        "tituloSerie" => "J Clin Psychiatry&#46;"
                        "fecha" => "2019"
                        "volumen" => "80"
                      ]
                    ]
                  ]
                ]
              ]
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            18 => array:3 [
              "identificador" => "bib0095"
              "etiqueta" => "19"
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                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "Ketamin und andere N-Methyl-D-Aspartat-Rezeptor-Modulatoren zur Behandlung der Depression"
                      "autores" => array:1 [
                        0 => array:2 [
                          "etal" => false
                          "autores" => array:3 [
                            0 => "S&#46; Vestring"
                            1 => "K&#46; Domschke"
                            2 => "C&#46; Normann"
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                        ]
                      ]
                    ]
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                  "host" => array:1 [
                    0 => array:2 [
                      "doi" => "10.1007/s00115-021-01221-1230"
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                        "tituloSerie" => "Nervenarzt&#46;"
                        "fecha" => "2021"
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              ]
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              "identificador" => "bib0100"
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                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "Continuous infusion ketamine for adjunctive analgosedation in mechanically ventilated&#44; critically ill patients"
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                        0 => array:2 [
                          "etal" => false
                          "autores" => array:5 [
                            0 => "P&#46;M&#46; Garber"
                            1 => "C&#46;A&#46; Droege"
                            2 => "K&#46;E&#46; Carter"
                            3 => "N&#46;J&#46; Harger"
                            4 => "E&#46;W&#46; Mueller"
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                    0 => array:2 [
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                        "tituloSerie" => "Pharmacotherapy&#46;"
                        "fecha" => "2019"
                        "volumen" => "39"
                        "paginaInicial" => "288"
                        "paginaFinal" => "296"
                        "link" => array:1 [
                          0 => array:2 [
                            "url" => "https://www.ncbi.nlm.nih.gov/pubmed/30746728"
                            "web" => "Medline"
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                0 => array:2 [
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                    0 => array:2 [
                      "titulo" => "Perioperative intravenous S-ketamine for acute postoperative pain in adults&#58; a systematic review and meta-analysis"
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                        0 => array:2 [
                          "etal" => false
                          "autores" => array:4 [
                            0 => "X&#46; Wang"
                            1 => "C&#46; Lin"
                            2 => "L&#46; Ln"
                            3 => "J&#46; Liu"
                          ]
                        ]
                      ]
                    ]
                  ]
                  "host" => array:1 [
                    0 => array:1 [
                      "Revista" => array:4 [
                        "tituloSerie" => "J Clin Anesthesiol&#46;"
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                          "pii" => "S009167491501372X"
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                          "issn" => "00916749"
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              "identificador" => "bib0110"
              "etiqueta" => "22"
              "referencia" => array:1 [
                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "Ketamine infusions for chronic pain&#58; a systematic review nd meta-analysis of randomized controlled trials"
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                        0 => array:2 [
                          "etal" => false
                          "autores" => array:4 [
                            0 => "V&#46; Orhurhu"
                            1 => "M&#46;S&#46; Orhurhu"
                            2 => "A&#46; Bhatia"
                            3 => "S&#46;P&#46; Cohen"
                          ]
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                      ]
                    ]
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                    0 => array:2 [
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                        "tituloSerie" => "Anesth Analg&#46;"
                        "fecha" => "2019"
                        "volumen" => "129"
                        "paginaInicial" => "241"
                        "paginaFinal" => "254"
                        "link" => array:1 [
                          0 => array:2 [
                            "url" => "https://www.ncbi.nlm.nih.gov/pubmed/31082965"
                            "web" => "Medline"
                          ]
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                ]
              ]
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            22 => array:3 [
              "identificador" => "bib0115"
              "etiqueta" => "23"
              "referencia" => array:1 [
                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "A systematic review and meta-analysis of ketamine as an alternative to opioids for acute pain in the emergency department"
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                        0 => array:2 [
                          "etal" => true
                          "autores" => array:6 [
                            0 => "N&#46; Karlow"
                            1 => "C&#46;H&#46; Schlaepfer"
                            2 => "C&#46;R&#46;T&#46; Stoll"
                            3 => "M&#46; Doering"
                            4 => "C&#46;R&#46; Carpenter"
                            5 => "G&#46;A&#46; Colditz"
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                        ]
                      ]
                    ]
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                  "host" => array:1 [
                    0 => array:2 [
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                        "tituloSerie" => "Acad Emerg Med&#46;"
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                        "volumen" => "25"
                        "paginaInicial" => "1086"
                        "paginaFinal" => "1097"
                        "link" => array:1 [
                          0 => array:2 [
                            "url" => "https://www.ncbi.nlm.nih.gov/pubmed/30019434"
                            "web" => "Medline"
                          ]
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                    ]
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                ]
              ]
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              "identificador" => "bib0120"
              "etiqueta" => "24"
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                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "A systematic review and meta-analysis of the efficacy of intravenous ketamine infusion for treatment resistant depression&#58; January 2009-January 2019"
                      "autores" => array:1 [
                        0 => array:2 [
                          "etal" => true
                          "autores" => array:6 [
                            0 => "W&#46;S&#46; Marcantoni"
                            1 => "B&#46;S&#46; Akoumba"
                            2 => "M&#46; Wassef"
                            3 => "J&#46; Marand"
                            4 => "H&#46; Lai"
                            5 => "S&#46; Richard-Devantoy"
                          ]
                        ]
                      ]
                    ]
                  ]
                  "host" => array:1 [
                    0 => array:2 [
                      "doi" => "10.1016/j.jad.2020.09.007"
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                        "tituloSerie" => "J Affect Disord&#46;"
                        "fecha" => "2020"
                        "volumen" => "277"
                        "paginaInicial" => "831"
                        "paginaFinal" => "841"
                        "link" => array:1 [
                          0 => array:2 [
                            "url" => "https://www.ncbi.nlm.nih.gov/pubmed/33065824"
                            "web" => "Medline"
                          ]
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                  ]
                ]
              ]
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              "identificador" => "bib0125"
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              "referencia" => array:1 [
                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "Ketamine for depression - evidence and proposals for practice"
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                        0 => array:2 [
                          "etal" => false
                          "autores" => array:4 [
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                            3 => "O&#46;A&#46; Andreassen"
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                    0 => array:1 [
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                        "tituloSerie" => "Tidsskr Nor Laegeforen&#46;"
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                          "pii" => "S0091674920315840"
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              "identificador" => "bib0130"
              "etiqueta" => "26"
              "referencia" => array:1 [
                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "Side-effects associated with ketamine use in depression&#58; systematic review"
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                        0 => array:2 [
                          "etal" => false
                          "autores" => array:5 [
                            0 => "B&#46; Short"
                            1 => "J&#46; Fong"
                            2 => "V&#46; Galvez"
                            3 => "W&#46; Shelker"
                            4 => "C&#46;K&#46; Loo"
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                        ]
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                    ]
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                  "host" => array:1 [
                    0 => array:1 [
                      "Revista" => array:6 [
                        "tituloSerie" => "Lancet Psychiatry&#46;"
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                          "issn" => "22132198"
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              ]
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            26 => array:3 [
              "identificador" => "bib0135"
              "etiqueta" => "27"
              "referencia" => array:1 [
                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "Antianhedonic effect of repeated ketamine infusions in patients with treatment resistant depression"
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                        0 => array:2 [
                          "etal" => false
                          "autores" => array:5 [
                            0 => "A&#46; Wilkowska"
                            1 => "M&#46;S&#46; Wiglusz"
                            2 => "M&#46; Ga&#322;uszko-Wegielnik"
                            3 => "A&#46; W&#322;odarczyk"
                            4 => "W&#46;J&#46; Cuba&#322;a"
                          ]
                        ]
                      ]
                    ]
                  ]
                  "host" => array:1 [
                    0 => array:1 [
                      "Revista" => array:3 [
                        "tituloSerie" => "Front Psychiatry&#46;"
                        "fecha" => "2021"
                        "volumen" => "12"
                      ]
                    ]
                  ]
                ]
              ]
            ]
            27 => array:3 [
              "identificador" => "bib0140"
              "etiqueta" => "28"
              "referencia" => array:1 [
                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "Cardiovascular effects of repeated subanaesthetic ketamine infusion in depression"
                      "autores" => array:1 [
                        0 => array:2 [
                          "etal" => true
                          "autores" => array:6 [
                            0 => "Y&#46;L&#46; Zhou"
                            1 => "W&#46;J&#46; Liu"
                            2 => "C&#46;Y&#46; Wang"
                            3 => "W&#46; Zheng"
                            4 => "X&#46;F&#46; Lan"
                            5 => "S&#46;Y&#46; Weng"
                          ]
                        ]
                      ]
                    ]
                  ]
                  "host" => array:1 [
                    0 => array:2 [
                      "doi" => "10.1177/0269881120936909"
                      "Revista" => array:6 [
                        "tituloSerie" => "J Psychopharmacol&#46;"
                        "fecha" => "2021"
                        "volumen" => "35"
                        "paginaInicial" => "159"
                        "paginaFinal" => "167"
                        "link" => array:1 [
                          0 => array:2 [
                            "url" => "https://www.ncbi.nlm.nih.gov/pubmed/32720857"
                            "web" => "Medline"
                          ]
                        ]
                      ]
                    ]
                  ]
                ]
              ]
            ]
            28 => array:3 [
              "identificador" => "bib0145"
              "etiqueta" => "29"
              "referencia" => array:1 [
                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "Heart rate variability and mortality in patients with end stage renal disease"
                      "autores" => array:1 [
                        0 => array:2 [
                          "etal" => false
                          "autores" => array:5 [
                            0 => "A&#46;K&#46; Cashion"
                            1 => "S&#46;L&#46; Holmes"
                            2 => "K&#46;L&#46; Arheart"
                            3 => "S&#46;R&#46; Acchiardo"
                            4 => "D&#46;K&#46; Hathaway"
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                        ]
                      ]
                    ]
                  ]
                  "host" => array:1 [
                    0 => array:1 [
                      "Revista" => array:6 [
                        "tituloSerie" => "Nephrol Nurs J&#46;"
                        "fecha" => "2005"
                        "volumen" => "32"
                        "paginaInicial" => "173"
                        "paginaFinal" => "184"
                        "link" => array:1 [
                          0 => array:2 [
                            "url" => "https://www.ncbi.nlm.nih.gov/pubmed/15889802"
                            "web" => "Medline"
                          ]
                        ]
                      ]
                    ]
                  ]
                ]
              ]
            ]
            29 => array:3 [
              "identificador" => "bib0150"
              "etiqueta" => "30"
              "referencia" => array:1 [
                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "Loss of fractal heart rate dynamics in depressive hemodialysis patients"
                      "autores" => array:1 [
                        0 => array:2 [
                          "etal" => true
                          "autores" => array:6 [
                            0 => "M&#46; Kojima"
                            1 => "J&#46; Hayano"
                            2 => "H&#46; Fukuta"
                            3 => "S&#46; Sakata"
                            4 => "S&#46; Mukai"
                            5 => "N&#46; Ohte"
                          ]
                        ]
                      ]
                    ]
                  ]
                  "host" => array:1 [
                    0 => array:2 [
                      "doi" => "10.1097/PSY.0b013e31816477a1"
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                        "tituloSerie" => "Psychosom Med&#46;"
                        "fecha" => "2008"
                        "volumen" => "70"
                        "paginaInicial" => "177"
                        "paginaFinal" => "185"
                        "link" => array:1 [
                          0 => array:2 [
                            "url" => "https://www.ncbi.nlm.nih.gov/pubmed/18256338"
                            "web" => "Medline"
                          ]
                        ]
                      ]
                    ]
                  ]
                ]
              ]
            ]
            30 => array:3 [
              "identificador" => "bib0155"
              "etiqueta" => "31"
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                0 => array:2 [
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                    0 => array:2 [
                      "titulo" => "Depression&#44; antidepressant use&#44; and risk of venous thromboembolism&#58; systematic review and meta-analysis of published observational evidence"
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                        0 => array:2 [
                          "etal" => false
                          "autores" => array:3 [
                            0 => "S&#46;K&#46; Kunutsor"
                            1 => "S&#46; Seidu"
                            2 => "K&#46; Khunti"
                          ]
                        ]
                      ]
                    ]
                  ]
                  "host" => array:1 [
                    0 => array:2 [
                      "doi" => "10.1080/07853890.2018.1500703"
                      "Revista" => array:6 [
                        "tituloSerie" => "Ann Med&#46;"
                        "fecha" => "2018"
                        "volumen" => "50"
                        "paginaInicial" => "529"
                        "paginaFinal" => "537"
                        "link" => array:1 [
                          0 => array:2 [
                            "url" => "https://www.ncbi.nlm.nih.gov/pubmed/30001640"
                            "web" => "Medline"
                          ]
                        ]
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                    ]
                  ]
                ]
              ]
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            31 => array:3 [
              "identificador" => "bib0160"
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              "referencia" => array:1 [
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Original language: English
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