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In relation to depression and its treatment, there are numerous medications that help in the treatment, whose mechanism of action is inhibiting selective serotonin reuptake or increasing the bioavailability of neurotransmitters in the central nervous system. However, a drug in the hypnotic class, ketamine increases the release of brainderived neurotrophic factor, a protein that helps neurons develop synapses. Ketamine also affects glutamate transmission by blocking NMDA receptors. This makes ketamine have antidepressant effects in patients with treatment-resistant depression. It also increases the speed at which these patients respond to antidepressant medications. One study administered ketamine intravenously at subanesthetic doses found that it could rapidly reduce symptoms of treatment-resistant depression in patients. This is a systematic review study that was designed based on the criteria established in the Preferred Reporting Items for Systematic Reviews and Meta-Analyses guide, considering the flow diagram and the PRISMA checklist. Ninety of the respondents who received the ketamine and oral antidepressant intervention showed an improvement. This review confirms that ketamine is beneficial in the treatment of patients with depressive disorder and generalized anxiety disorder. However, ketamine showed excellent results associated with antidepressants compared to other drugs, for example midazolam did not reduce 50% of the Montgomery-Asberg depression scale score.

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Sepsis is a systemic proinflammatory response caused by bacterial, fungal, viral, autoimmune diseases causing dysfunction of one or more organs or systems. In this context, the aim of this study was to compile the literature on the impact of implementing the sepsis protocol on lower mortality and morbidity, to elucidate risk factors and possible interventions. A total of 55 studies were identified according to our search strategy. After applying the adopted inclusion and exclusion criteria, a total of 31 studies in Medline/Pubmed and Medline/BVS were excluded. Then the titles, abstracts and the full text were read, 20 of the 24 references were excluded based on the eligibility criteria. Thus, 4 references were selected for full text evaluation. Finally, four articles were eligible for qualitative evaluation. Despite the early institution of therapeutic measures advocated in the international literature, mortality from sepsis in the institution in question is still high. All references demonstrate the association of better prognosis for early diagnosis of sepsis with respect to protocol adoption, with P-value lower than the significance level = 0.05. This review corroborates that there are still gaps in the treatment of sepsis. However, the implementation of this protocol allows for a better diagnosis of sepsis, reduces possible early sepsis diagnoses, and promotes the effective use of antimicrobial agents in this population. Therefore, we need to investigate more closely the associated risk factors and the implementation of sepsis protocols to obtain a possible effective intervention.

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