Roughly a quarter of the world's population, or 2 billion people, has serological evidence of past or present hepatitis B virus (HBV) infection. A total of 250 million people are estimated to have chronic hepatitis B (CHB) infection. It is further estimated that almost 700,000 die of HBV per year, with 300,000 because of the development of HBV-induced hepatocellular carcinoma, the second most common cause of death from cancer. 1,2 This is true despite the presence of a safe and effective vaccine and the availability of efficient therapy. In industrialized Western countries, including the United States, immigrants from hepatitis B-endemic areas represent an important source of new HBV infections. 3 This group represents a much greater risk than, for example, the intravenous drug user population, which is estimated to account worldwide for slightly more than a million CHB infections, whereas the immigrant HBV population in the United States alone is estimated at 1.6 million. 3 HBVendemic countries are defined as countries hyperendemic for HBV where more than 8% of the population is HBV infected, as well as countries displaying intermediate endemicity with an HBV prevalence rate between 2% and 8%. Countries in the Middle Eastern region belong to the latter group and, because of their political instability, have recently become an important source of migration. The discussion of the current HBV epidemiology and in general the burden of HBV in this area is thus timely and is the aim of this review. HBv ePiDeMiOlOGYMiddle Eastern countries are considered developing countries that possess a suboptimal health care infrastructure. Reliable data on epidemiology may be difficult to obtain. In such areas, assessing HBV prevalence in blood donors appears attractive because they are based on a large number of individuals. Data obtained from blood donor studies can be considered acceptable indicators of the HBV burden in developing countries provided it is understood that these prevalence data underestimate the real problem because high-risk groups for HBV are rejected from blood donation without pretransfusion blood screening for hepatitis B surface antigen (HBsAg). 4

Objectives: To assess gastrointestinal and cardiovascular diabetic autonomic neuropathy in patients with type 2 diabetes mellitus (DM). Materials and Methods:The study group composed of DM patients examined between March and September 2012. Age, body mass index (BMI), fasting blood glucose, HbA1c, C-peptide, duration of diabetes, electrocardiogram, blood pressure, heart rate were recorded. Patients were grouped as controlled and uncontrolled diabetics. Cardiac autonomic neuropathy (CAN) tests were done. Rectoanal inhibitory reflex, resting and squeeze pressures were measured by anal manometry. Results: A total of 50 DM patients were enrolled and the mean age of patients was 57.06±8.92 years, the mean resting anal pressure was 55.92±14.84 mmHg, and squeezing anal pressure was 83.15±31.00 mmHg. There was no significantly different resting anal pressure between mild and severe CAN groups (p=0.573), but maximum squeezing pressure was significantly different between mild and severe CAN groups (p=0.005). Anal manometric pressures were not different in patients with short or long duration of diabetes. BMI was not associated with CAN, whereas age was. Bad glycemic control was associtated with a decrease in resting pressures, but no significant difference between maximum squeeze pressures and insufficient glycemic control groups. Severity of CAN was associated with a decrease in maximum squeeze pressures. Conclusion: Cardiac and gastrointestinal autonomic dysfunction are important complications of DM. Anal manometric tests and CAN may show these complications of diabetes. Key words: Manometry, type 2 diabetes mellitus, diabetic autonomic neuropathy Öz Amaç: Tip 2 diabetes mellituslu (DM) hastalarda gastrointestinal ve kardiyovasküler diyabetik otonomik nöropatinin değerlendirilmesi amaçlanmaktadır. Materyal ve Metot: DM hastalarından oluşan çalışma grubu Mart-Eylül 2012 tarihleri arasında incelendi. Yaş, vücut kütle indeksi (VKİ), açlık kan glukozu, HbA1c, C-peptid, diyabet süresi, elektrokardiyogram, kan basıncı, kalp hızı kaydedildi. Hastalar kontrol altında olan ve olmayan diyabetikler olarak gruplandırıldı. Kardiyak otonom nöropati (KON) testleri değerlendirildi. Anal manometri ile rekto-anal inhibitör refleks, istirahat ve sıkma basınçları ölçüldü. Bulgular: Toplam 50 DM hastası çalışmaya kaydedildi ve hastaların yaş ortalaması 57,06±8,92 yıl, istirahat anal basıncı ortalaması 55,92±14,84 mmHg ve sıkma anal basıncı ortalaması 83,15±31,00 mmHg idi. Orta ve ağır KON grupları arasında istirahat anal basıncında anlamlı fark saptanmazken (p=0,573), orta ve ağır KON grupları arasında maksimum sıkma basıncında anlamlı fark mevcuttu (p=0,005). Kısa veya uzun süreli diyabeti olan hastalarda anal manometrik basınçlarda fark saptanmadı. KON ile VKİ arasında ilişki bulunmazken yaş ile ilişki saptandı. Kötü glisemik kontrol istirahat basında azalma ile ilişkili iken, maksimum sıkma basıncı ve yetersiz glisemik kontrol grubu arasında ilişki yoktu. KON'un şiddeti maksimum sıkma basıncında azalma ile ilişkiliydi. Sonuç: Kar...