Objective: To perform a cost-utility analysis on the treatment of attention deficit hyperactivity disorder (ADHD) with methylphenidate immediate-release (MPH-IR) in children and adolescents from Brazil. Method: A Markov model was constructed to compare MPH-IR vs. no treatment. A 24-week naturalistic study was conducted to collect transition probabilities and utility data. Effectiveness was expressed as quality-adjusted life-years (QALY), and costs reported in 2014 international dollars (I$). The perspective was the Brazilian Unified Health System as payer, and the time horizon was 6 years. Results: Of 171 patients, 73 provided information at baseline, and 56 at week 24. Considering the MPH-IR monthly cost of I$ 38, the incremental cost-effectiveness ratio (ICER) of treatment was I$ 9,103/QALY for children and I$ 11,883/QALY for adolescents. In two-way sensitivity analysis, considering one Gross National Product per capita (I$ 11,530) as willingness-to-pay, a cost of no-treatment lower than I$ 45/month would render MPH-IR a cost-saving strategy. Discussion: MPH-IR treatment of children and adolescents is cost-effective for ADHD patients from the Brazilian public health system perspective. Both patients and the healthcare system might benefit from such a strategy. Trial registration number: NCT01705613.

Irritability is defined as a low threshold to experience anger in response to frustration. It is one of the most common symptoms in youth and is part of the clinical presentation of several disorders. Irritability can present early in life and is a predictor of long-term psychopathology; yet, the diagnostic status of irritability is a matter of intense debate. In the present article, we address two main components of the debate regarding irritability in youth: the misdiagnosis of chronic irritability as pediatric bipolar disorder, and the proposal of a new diagnosis in the DSM-5, disruptive mood dysregulation disorder, whose defining symptoms are chronic irritability and temper outbursts.

A síndrome de Lambert-Eaton é um distúrbio autoimune raro e adquirido. Apresentamos duas pacientes com paresia do reto medial como única manifestação ocular. Após retrocesso do reto lateral e ressecção do reto medial, unilateral, ambas as pacientes apresentaram normalização da adução. Até onde sabemos, este é o primeiro relato de cirurgia para paresia do reto medial na síndrome de Lambert-Eaton.

Lambert-Eaton myasthenic syndrome is a rare and acquired autoimmune disorder. We describe two female patients with medial rectus paresis as the only ocular manifestation. After a unilateral medial rectus recession and lateral rectus resection procedure, both patients recovered normal adduction. To our knowledge, this is the first report of surgery for extraocular muscle paresis in Lambert-Eaton myasthenic syndrome.

Diplopia intratável tem sido descrita em várias situações. Métodos convencionais como prismas e correção cirúrgica do estrabismo falham em neutralizá-la. O objetivo do trabalho é documentar o caso de uma paciente com estrabismo de longa data, cuja diplopia deteriorou-se ao longo dos anos, e não foi possível resolução com cirurgia, prisma, e oclusão com óculos e lente de contato com pupila opaca. A paciente foi então submetida à facoemulsificação com implante de lente intra-ocular opaca que atingiu o objetivo desejado.

Intractable diplopia has been described in many situations but poor results are the rule with standard treatment modalities. The authors report a case of a woman with long-standing strabismus and diplopia who failed to improve following surgery, prism, and occlusive spectacles or contact lenses. Then, she was submitted to phacoemulsification and opaque intraocular lens implantation, which successfully neutralized diplopia.

Objetivo: Analisar o efeito do debilitamento do oblíquo superior associado à transposição anterior do oblíquo inferior em casos de pacientes com DVD (divergência vertical dissociada) e hiperfunção do músculo oblíquo superior (HOS). Métodos: Em 14 pacientes foram analisadas a correção média da divergência vertical dissociada da hiperfunção do músculo oblíquo superior e da anisotropia em A. A cirurgia de tenectomia do oblíquo superior e a transposição anterior do músculo oblíquo inferior foram realizadas nos 28 olhos. Resultados: A redução da divergência vertical dissociada foi de 65,5% no olho direito (OD) e de 61,3% no olho esquerdo (OE). A correção da hiperfunção do músculo oblíquo superior foi de 81,8% no olho direito e de 85,0% no olho esquerdo. Houve redução de 92,2% da anisotropia em A. Estas correções foram estatisticamente significantes (p<0,01). Conclusões: A cirurgia proposta se mostrou eficaz na correção da divergência vertical dissociada e da hiperfunção do músculo oblíquo superior.

Purpose: To analyze the effect of weakening of the superior oblique muscle (HOS) with anterior transposition of the inferior oblique muscle in patients with dissociated vertical deviation (DVD) associated with overaction of superior oblique muscle. Methods: In 14 patients we analyzed the correction of dissociated vertical deviation, the reduction of the superior oblique overaction, and the reduction of the A pattern. Twenty-eight eyes were submitted to anterior transposition of the inferior oblique, and tenectomy of the superior oblique muscle. Results: The correction of dissociated vertical deviation was 65.5% in right eye (RE) and 61.3% in left eye (LE). The reduction in the superior oblique overaction was 81.8% in and right eye 85.0% in left eye. The A pattern was reduced in 92.2%. All these values were statistically significant (p<0.01). Conclusions: The proposed surgery is effective in the correction of dissociated vertical deviation and overacting superior oblique muscle.