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Hepatitis B (HBV) reactivation (HBVr) is a potentially fatal complication in patients with past HBV exposure receiving immunosuppressive therapy. HBVr can occur in patients with chronic HBV infection as well as in patients with resolved HBV infection. In this article, we present the cases of four patients with resolved hepatitis B who presented with HBVr during or after immunosuppressive treatment, of whom two died as a consequence of HBVr. We then reflect on and summarize the recommendations of four major societies for the screening and management of previously HBV-exposed patients planned to receive immunosuppressive treatment. Current guidelines recommend screening for HBV in all patients planned to receive immunosuppressive therapy. Risk of HBVr is assessed based on the serological status of the patient and the planned immunosuppressive drug regimen. For patients considered to be at low risk of HBVr, management consists of serological monitoring for HBVr and immediate preemptive antiviral therapy in the case of HBVr. For patients considered to be at intermediate or high risk for HBVr, antiviral prophylaxis should be initiated concordantly with the immunosuppressive therapy and continued for up to 18 months after cessation of the immunosuppressive regimen. Areas of uncertainty include the risk of novel and emerging immunosuppressive and immune modulatory drugs and the exact duration of antiviral prophylaxis. Greater awareness is needed among clinicians regarding the risk of HBVr in patients receiving immunosuppressive therapy, especially in low-endemicity settings. Implementation of screening and management programs and decision support tools based on the presented guidelines may improve the management of these patients. [ABSTRACT FROM AUTHOR]

A first application of geomorphological methods to the assessment of sandstone deterioration at Angkor is presented. Damage diagnosis was carried out on the first eastern tier of the central pyramid of the 1,000 year-old Ta Keo temple. Methods combine field observations and measurements at 230 sampling points, high-resolution lasergrammetry and stereophotogrammetry on a 2-m2 test zone, and SEM observations. The first results indicate that decay operates through a synergistic combination of weathering phenomena dominated by scaling and solution, and exhibits a high spatial variability. Percentages of deteriorated surfaces vary from 17.6 to 93.8%, and average stone recession values from 0.00 to 2.71 cm (minimum) and 0.34 to 5.49 cm (maximum). On the test-zone, stereophotogrammetry and 3D-mapping of the present and reconstructed initial states using lasergrammetry indicate that erosion scars up to 6 cm deep have formed since 1963. On the whole, the amount of deteriorated surfaces more than tripled between 1963 and 2008. The degree of implication of salts in stone decay remains unclear for most efflorescences are composed of calcite (CaCO3), with secondary importance of barite (BaSO4) and gypsum (CaSO4·2H2O). Future prospects aim to evaluate the impact on stone decay of the clearing out of the temple from the forest in the 1920s. [ABSTRACT FROM AUTHOR]

Tsunamis and intense tropical storms compete as viable mechanisms for catastrophic marine inundations of coastlines, and so interpretation of deposits laid down by palaeo-events is often problematic. Here, examples are presented from the tropical South Pacific Islands to demonstrate how indigenous knowledge may provide vital clues supporting sedimentological investigation and thereby helping to explain the origin of giant boulders emplaced on top of coral reef platforms. [ABSTRACT FROM AUTHOR]