ABSTRACT A literature review on the clinical, laboratory, and treatment features of type B insulin resistance syndrome (TBIRS). Data from PubMed, the Virtual Health Library and Cochrane database were selected and analyzed using the REDCap application and R statistical program. From 182 papers, 65 were selected, which assessed 119 clinical cases, 76.5% in females and 42.9% in African-Americans, with an average age of 44 years. A common feature of TBIRS is co-occurrence of autoimmune diseases, such as systemic lupus erythematosus (most frequently reported). Hyperglycemia of difficult control was the mostly reported condition. Tests for anti-insulin receptor antibodies were positive in 44.2% of the cases. Disease management comprised fractional diet, insulin therapy (maximum dose given was 57 600 IU/day), plasmapheresis and immunosuppression with several classes of drugs, mainly glucocorticoids. Remission occurred in 69.7% of cases, in 30.3% of these spontaneously. The mortality rate was 15.38%. There was an inverse relationship between anti-insulin antibodies and remission (p = 0.033); and a positive correlation between combined immunosuppressive therapy and remission (p = 0.002). Relapse occurred in 7.6% of the cases. This rare syndrome has difficult-to-control diabetes, even with high doses of insulin, and it is usually associated with autoimmune diseases. Therapeutic advances using immunomodulatory therapy have led to significant improvements in the rate of remission.

OBJETIVO: Investigar as alterações metabólicas no olho e sangue arterial de ratos Wistar submetidos ao pinçamento bilateral das artérias carotídeas. MÉTODOS: Trinta e seis ratos machos adultos foram submetidos a dissecção (grupo-1, sham, n=18) ou dissecção+pinçamento (grupo-2, experimento, n=18) das artérias carotídeas comuns, sob anestesia geral. Após 30 minutos de isquemia (tempo 0) e durante a reperfusão (15-30 minutos) foram colhidas amostras de sangue arterial. Simultaneamente procedeu-se a enucleação do olho direito. RESULTADOS: O aumento significante (p<0,05) das concentrações de piruvato tissular (tempo 0) no grupo-2 comparado ao controle sugere menor utilização do piruvato pelo tecido isquêmico. O aumento significante (p<0,05) do lactato tissular (grupo-2 versus grupo-1), no tempo 0, permanecendo elevado durante toda a fase de reperfusão, sugere uso continuado da via glicolítica anaeróbica, apesar da oferta de O2, nos tecidos lesados pela isquemia-reperfusão. Maior captação (grupo-1) pode ter sido a causa do aumento significante das concentrações de corpos cetônicos no olho, na reperfusão (15-30 minutos). CONCLUSÃO: A oclusão carotídea bilateral, durante 30 minutos, induz significativas alterações no metabolismo energético do tecido ocular, com manutenção da via glicolítica anaeróbica após restabelecimento do fluxo arterial.

PURPOSE: To investigate the metabolic alterations in the eye and arterial blood of Wistar rats submitted to bilateral common carotid artery clamping. METHODS: thirty-six males adult rats were submitted the dissection (group-1, sham, n=18) or dissection+clamping (group-2, experimental, n=18) of common carotid arteries, under general anesthesia. After 30 minutes of ischemia (time 0) and during reperfusion (15-30 minutes) arterial blood samples were collected. Simultaneously right eye enucleation was carried out. RESULTS: The significant decrease of tissue piruvate concentrations 15 min (0,693±0,132 versus 1,195±0,118 µmol/g, p<0,01) and 30 min (0,764±0,182 versus 1,195±0,118 µmol/g, p<0,05) of onset of reperfusion (time 0) in group-2 rats suggests increased use of piruvate for energy production in Krebs cycle. The significant increase of tissue lactate (group-2 versus group-1), in time 0 (8,843±0,902 versus 3,134±1,182 µmol/g, p<0,01) remaining elevated during the whole reperfusion phase, suggests continuous use of the anaerobic glicolytical pathway, in spite of the offer of O2, in ischemia-reperfusion injured tissues. Increased uptake (group-1) might have been the cause for the significant increase of ketone bodies concentrations in the eye, during reperfusion (15-30 minutes). CONCLUSION: Bilateral carotid artery occlusion, for 30 minutes, induces significant alterations in the energetic metabolism of eye tissue, with maintenance of the anaerobic glicolytical pathway after re-establishment of the arterial flow.