Use Of Molecular Epidemiology To Monitor The Nosocomial Dissemination Of Methicillin-resistant Staphylococcus Aureus Un A University Hospital From 1991 To 2001

Methicillin-resistant Staphylococcus aureus (MRSA) has been the cause of major outbreaks and epidemics among hospitalized patients, with high mortality and morbidity rates. We studied the genomic diversity of MRSA strains isolated from patients with nosocomial infection in a University Hospital from 1991 to 2001. The study consisted of two periods: period I, from 1991 to 1993 and period II from 1995 to 2001. DNA was typed by pulsed-field gel electrophoresis and the similarity among the MRSA strains was determined by cluster analysis. During period 1, 73 strains presented five distinctive DNA profiles: A, B, C, D, and E. Profile A was the most frequent DNA pattern and was identified in 55 (75.3%) strains; three closely related and four possibly related profiles were also identified. During period II, 80 (68.8%) of 117 strains showed the same endemic profile A identified during period I, 18 (13.7%) closely related profiles and 18 (13.7%) possibly related profiles and, only one strain presented an unrelated profile. Cluster analysis showed a 96% coefficient of similarity between profile A from period I and profile A from period II, which were considered to be from the same clone. The molecular monitoring of MRSA strains permitted the determination of the clonal dissemination and the maintenance of a dominant endemic strain during a 10-year period and the presence of closely and possibly related patterns for endemic profile A. However, further studies are necessary to improve the understanding of the dissemination of the endemic profile in this hospital.37913451351Fluckiger, U., Widmer, A.F., Epidemiology of methicillin-resistant Staphylococcus aureus (1999) Chemotherapy, 45, pp. 121-134Deplano, A., Schuermans, A., Van Eldere, J., Multicenter evaluation of epidemiological typing of methicillin-resistant Staphylococcus aureus strains by repetitive-element PCR analysis (2000) Journal of Clinical Microbiology, 38, pp. 3527-3533Stranden, A., Frei, R., Widmer, A.F., Molecular typing of methicillin-resistant Staphylococcus aureus: Can PCR replace pulsed-field gel electrophoresis? (2003) Journal of Clinical Microbiology, 41, pp. 3181-3186Wang, J.T., Chen-Chun, Y., Yang, T.L., Chang, C.S., Molecular epidemiology and antimicrobial susceptibility of methicillin-resistant Staphylococcus, aureus in Taiwan (2002) Diagnostic Microbiology and Infectious Disease, 42, pp. 199-203Tambic, A., Power, E.G.M., Talsania, H., Anthony, R.M., French, G.L., Analysis of an outbreak of non phage-typeable methicillin-resistant Staphylococcus aureus by using a randomly amplified polymorphic DNA assay (1997) Journal of Clinical Microbiology, 35, pp. 3092-3097Conterno, L.O., Wey, S.B., Castello, A., Risk factors for mortality in Staphylococcus aureus bacteremia (1998) Infection Control and Hospital Epidemiology, 19, pp. 32-37Pujol, M., Penã, C., Pallares, R., Ayats, J., Arisa, J., Gudiol, F., Risk factors for nosocomial bacteremia due to methicillin-resistant Staphylococcus aureus (1996) European Journal of Clinical Microbiology and Infectious Diseases, 13, pp. 96-102Archer, G.L., Niemeyer, D.M., Origin and evolution of DNA associated with resistance to methicillin in Staphylococci (1998) Trends in Microbiology, 2, pp. 343-347Witte, W., Kresken, M., Braulke, C., Cuny, C., Increasing incidence and widespread dissemination of methicillin-resistant Staphylococcus aureus (MRSA) in hospitals in central Europe, with special reference to German hospitals (1997) Clinical Microbiology and Infection, 3, pp. 414-422Corso, A., Santos, S.I., Aires de Souza, M., Rossi, A., Lencastre, H., Spread of a methicillin-resistant and multiresistant epidemic clone of Staphylococcus aureus (1998) Journal of Medical Microbiology, 4, pp. 179-184Alfizah, H., Norazah, A., Nordiah, A.J., Lim, V.K., DNA fingerprinting of methicillin-resistant Staphylococcus aureus (MRSA) by pulsed-field gel electrophoresis (PFGE) in a teaching hospital in Malaysia (2002) Medical Journal of Malaysia, 57, pp. 319-328Sola, C., Gribaudo, G., Vindel, A., Patrito, L., Bocco, J.L., Identification of a novel methicillin-resistant Staphylococcus aureus epidemic clone in Cordoba, Argentina, involved in nosocomial infections (2002) Journal of Clinical Microbiology, 40, pp. 1427-1435Melter, O., Aires de Sousa, M., Urbaskova, P., Jakubu, V., Zemlickova, H., Lencastre, H., Update on the major clonal types of methicillin-resistant Staphylococcus aureus in the Czech Republic (2003) Journal of Clinical Microbiology, 41, pp. 4998-5005Sader, H.S., Pignatari, A.C., Hollis, R.J., Jones, R.N., Evaluation of inter-hospital spread of methicillin-resistant Staphylococcus aureus in São Paulo using pulsed-field gel electrophoresis of chromosomal DNA (1994) Infection Control and Hospital Epidemiology, 15, pp. 320-323Santos, F.L., Sader, H., Bortolotto, V.I., Gontijo, F.P.P., Pignatari, A.C., Analysis of the clonal diversity of Staphylococcus aureus methicillin-resistant strains isolated at João Pessoa, State of Paraíba, Brazil (1996) Memórias Do Instituto Oswaldo Cruz, 91, pp. 101-105Moretti-Branchini, M.L., Aplicação de métodos de tipagem molecular na investigação de surtos intra-hospitalares (1998), Livre-docência thesis, Faculdade de Ciências Médicas, Universidade Estadual de Campinas, Campinas, SP, BrazilPottinger, J.M., Herwaldt, L.A., Peri, T.M., Basics of surveillance: An overview (1999) Infection Control and Hospital Epidemiology, 18, pp. 513-527Loureiro, B.A., De Moraes, B.A., Quadra, M.R.R., Pinheiro, G.S., Suffys, P.N., Asensi, M.D., Molecular epidemiology of methicillin resistant Staphylococcus aureus isolated from newborns in a hospital in Rio de Janeiro, Brazil (2000) Memórias Do Instituto Oswaldo Cruz, 95, pp. 777-782Blanc, D.S., Struelens, M.J., Deplano, A., Hauser, P.M., Petgnat, C., Franioli, P., Epidemiological validation of pulsed-field gel electrophoresis patterns for methicillin-resistant Staphylococcus aureus (2001) Journal of Clinical Microbiology, 39, pp. 3442-3445Tenover, F.C., Gaynes, R.P., The epidemiology of Staphylococcus infection (2000) Gram-Positive Pathogens, , Fischetti VA, Novick RP, Ferretti JJ, Portnoy DA & Rood JL (Editors), American Society for Microbiology, Washington, DC, USASchmitz, F.J.M., Steiert, H.V., Tichy, B., Hofmann, J., Verhoef, H.P., Heinz, K., Köhrer, T., Jones, M.E., Typing of methicillin-resistant Staphylococcus aureus isolates from Düsseldorf by six genotypic methods (1998) Journal of Clinical Microbiology, 47, pp. 341-351Montesianos, I., Salido, E., Delgado, T., Cuervo, M., Sierra, A., Epidemiologic genotyping of methicillin-resistant Staphylococcus aureus by pulsed-field gel electrophoresis at a university hospital and comparison with antibiotyping and protein A and coagulase gene polymorphisms (2002) Journal of Clinical Microbiology, 40, pp. 921-925Tenover, F.C., Arbeit, R.D., Goering, R.V., Mickelsen, P.A., Murray, B.E., Persing, D.H., Swaminathan, B., Interpreting chromosomal DNA restriction patterns produced by pulsed-field gel electrophoresis: Criteria for bacterial strain typing (1995) Journal of Clinical Microbiology, 33, pp. 2233-2239Barbier, N., Saulnier, P., Chachaty, E., Dumontier, S., Remont, A., Random amplified polymorphic DNA typing versus pulsed-field gel electrophoresis for epidemiological typing of vancomycin-resistant enterococci (1996) Journal of Clinical Microbiology, 34, pp. 1096-1099Olive, M., Bean, P., Principles and application of methods for DNA-based typing of microbial organisms (1995) Journal of Clinical Microbiology, 37, pp. 1661-1669Fujino, T., Sekiguchi, J.I., Kawana, A., Molecular epidemiology of methicillin-resistant Staphylococcus aureus in a Tokyo hospital in 2002 (2003) Journal of Infectious Diseases, 55, pp. 210-213Tenover, F.C., Arbeit, R.D., Goering, R.V., How to select and interpret molecular strain typing methods for epidemiological studies of bacterial infections: A review for healthcare epidemiologists (1997) Infection Control and Hospital Epidemiology, 18, pp. 426-439Garner, J.S., Jarvis, W., Emori, T.G., Horan, T.C., Hughes, J.M., CDC definitions for nosocomial infections (1988) American Journal of Infection Control, 16, pp. 128-140Bauer, A.W., Kirby, W.M.M., Sherris, J.C., Turck, M., Antibiotic susceptibility testing by a standardized single disk method (1996) American Journal of Clinical Pathology, 45, pp. 493-496(1999) Performance Standards for Antimicrobial Susceptibility Testing, , National Committee for Clinical Laboratory Standards (NCCLS) Ninth Informational Supplement M100-S9Aires De Sousa, M., Crisostomo, M.I., Santos Sanches, I., Wu, J.S., Fuzhong, J., Tomasz, A., De Lencastre, H., Frequent recovery of a single clonal type of multidrug-resistant Staphylococcus aureus from patients in two hospitals in Taiwan and China (2003) Journal of Clinical Microbiology, 41, pp. 159-163Teixeira, L., Resende, C.A., Ormonde, L.R., Rosenbaum, R., Figueiredo, A.M.S., Lencastre, H., Tomasz, A., Geographic spread of epidemic multiresistant Staphylococcus aureus clone in Brazil (1995) Journal of Clinical Microbiology, 33, pp. 2400-2404Tambic, A., Power, E.G.M., Tambic, T., Snur, I., French, G.L., Epidemiological analysis of methicillin-resistant Staphylococcus aureus in a Zagreb trauma hospital using a randomly amplified polymorphic DNA-typing method (1999) European Journal of Clinical Microbiology and Infectious Diseases, 18, pp. 335-340Miragaia, M., Couto, I., Pereira Sandro, F.F., Molecular characterization of methicillin-resistant Staphylococcus epidermidis: Evidence of geographic dissemination (2002) (2003) Journal of Clinical Microbiology, 40, pp. 430-438Boyce, J.M., Treatment and control of colonization in the prevention of nosocomial infections (1996) Infection Control and Hospital Epidemiology, 17, pp. 256-261Salmenlinna, S., Vuopio-Varkila, J., Recognition of two groups of methicillin-resistant Staphylococcus aureus strains based on epidemiology, antimicrobial susceptibility, hypervariable-region type, and ribotype in Finland (2001) Journal of Clinical Microbiology, 39, pp. 2243-2247El-Din, S.A.S., El-Shafey, E.I., Mohamad, B., El-Hadidy, M.R., El-Din, A.B., El-Hadidy, M.M., Zaghloul, H.A., Methicillin-resistant Staphylococcus, aureus: A problem in the burns unit (2003) Egyptian Journal of Plastic and Reconstructive Surgery, 27, pp. 1-10Walker, J., Borrow, R., Goering, R.V., Egerton, S., Fox, A., Oppenhein, B.A., Subtyping of methicillin-resistant Staphylococcus aureus isolates from the North-West of England: A comparison of standardized pulsed-field gel electrophoresis with bacteriophage typing including an inter-laboratory reproducibility study (1999) Journal of Medical Microbiology, 48, pp. 297-301Waller, T.M.A., Methicillin-resistant Staphylococcus aureus typing methods: Which should be international standard? (2000) Journal of Hospital Infection, 44, pp. 160-172McDougal, L.K., Steward, C.D., Killgore, G.E., Chaitram, J.M., McAllister, S.K., Tenover, F.C., Pulsed-field gel electrophoresis typing of oxacillin-resistant Staphylococcus aureus isolates from the United States: Establishing a national database (2003) Journal of Clinical Microbiology, 41, pp. 5113-512

Dabigatran overload in acute kidney injury: haemodialysis or idarucizumab? A case report and proposal for a decisional algorithm

Dabigatran overload has been reported in acute kidney injury (AKI), leading to occasional major bleeding. Haemodialysis (HD) was the method used for reversing dabigatran anticoagulant effects before the approval of idarucizumab, which is now indicated for dabigatran reversal in major bleeding or surgical emergencies. There have been reports of rebound of dabigatran levels following idarucizumab administration in AKI, requiring HD to achieve effective dabigatran clearance. However, a decisional algorithm to individualize treatments for dabigatran overload seems lacking. We present a case of dabigatran accumulation in obstructive AKI with minor bleeding that was successfully treated with HD and tranexamic acid without using idarucizumab, and propose a decision-making algorithm including different pathways in the management of suspected dabigatran overload in AKI

Use Of Molecular Epidemiology To Monitor The Nosocomial Dissemination Of Methicillin-resistant Staphylococcus Aureus In A University Hospital From 1991 To 2001.

Methicillin-resistant Staphylococcus aureus (MRSA) has been the cause of major outbreaks and epidemics among hospitalized patients, with high mortality and morbidity rates. We studied the genomic diversity of MRSA strains isolated from patients with nosocomial infection in a University Hospital from 1991 to 2001. The study consisted of two periods: period I, from 1991 to 1993 and period II from 1995 to 2001. DNA was typed by pulsed-field gel electrophoresis and the similarity among the MRSA strains was determined by cluster analysis. During period I, 73 strains presented five distinctive DNA profiles: A, B, C, D, and E. Profile A was the most frequent DNA pattern and was identified in 55 (75.3%) strains; three closely related and four possibly related profiles were also identified. During period II, 80 (68.8%) of 117 strains showed the same endemic profile A identified during period I, 18 (13.7%) closely related profiles and 18 (13.7%) possibly related profiles and, only one strain presented an unrelated profile. Cluster analysis showed a 96% coefficient of similarity between profile A from period I and profile A from period II, which were considered to be from the same clone. The molecular monitoring of MRSA strains permitted the determination of the clonal dissemination and the maintenance of a dominant endemic strain during a 10-year period and the presence of closely and possibly related patterns for endemic profile A. However, further studies are necessary to improve the understanding of the dissemination of the endemic profile in this hospital.371345-5

La difesa dai terremoti in Lombardia: stato dell’arte e prospettive

L’INGV (http://www.mi.ingv.it/) svolge in Lombardia ricerche nel campo della mitigazione del rischio sismico, mediante studi mirati al miglioramento delle conoscenze sulla storia sismica, sul modello strutturale legato al regime tettonico in atto e alla definizione del moto del suolo atteso. Accanto alle indagini necessarie alla caratterizzazione sismogenetica e dei possibili effetti dello scuotimento sismico, si pone l’attività di monitoraggio sismico, che la Sezione di Milano-Pavia espleta mediante la rete accelerometrica (RAIS, http://rais.mi.ingv.it/) che consta di 20 postazioni distribuite in prevalenza sul territorio regionale. In un recente lavoro di sintesi - di studi pluriennali su fonti storiche e di revisioni critiche di materiali pubblicati - si è tentato di colmare l’evidente carenza conoscitiva sulle caratteristiche della sismicità storica dell’area lombarda. Tale carenza è particolarmente evidente se si rapportano le informazioni oggi disponibili sui terremoti del passato in quest’area con quelle relative al settore veneto-friulano. La regione analizzata, compresa tra il bacino del fiume Adda e il Lago di Garda, è stata caratterizzata da alcuni terremoti con Mw>5.5 (es., 1117, Veronese; 1222, Brescia; 1901, Salò) e vari eventi con Mw compresa fra 4.8 e 5.5 (es., 1065, Brescia; 1396, Monza; 1642, Bergamo). Per molti degli eventi sismici fino al 1700 le informazioni sono desumibili soltanto da scarse fonti storiche. La determinazione epicentrale e l’attribuzione della magnitudo per tali eventi sono da considerarsi, pertanto, con una certa cautela al fine di definire le caratteristiche sismiche del territorio. I terremoti del 1117 e del 1222, in tale contesto, rappresentano un’eccezione rispetto ai dati generalmente disponibili. E tuttavia vari problemi tuttora aperti rendono assai difficile l’utilizzo della distribuzione del danno attribuibile a questi eventi nella prospettiva di un’affidabile parametrizzazione. Le indagini geologico-strutturali e di geologia del Quaternario, finalizzate a definire un quadro strutturale compatibile con il regime tettonico in atto, sono necessarie per giustificare la storia sismica e, in sostanza, per definire il comportamento sismogenetico della regione. Le geometrie dei sistemi di faglia attivi alpini sono ora sufficientemente noti. Le conoscenze permettono di formulare ipotesi sismotettoniche relative all’origine dei terremoti dell’area gardesana e del Bresciano. In via di definizione sono invece le geometrie dei fronti appenninici, cui sono attribuibili i terremoti al di sopra della soglia nel settore padano. Le ricerche attuali sono altresì indirizzate ad una migliore caratterizzazione del complesso settore compreso tra la parte meridionale del Lago di Garda (area di Sirmione), Verona e Mantova, all’interno del quale potrebbe collocarsi l’area epicentrale del terremoto del 1117 (o una delle aree epicentrali, qualora si considerasse questo evento come rappresentato da una sequenza sismica). Uno dei settori regionali con maggiore frequenza di eventi sismici è l’area gardesana occidentale, per questo motivo la rete di monitoraggio presenta una notevole densità di postazioni nel Bresciano e se ne è pianificato l’addensamento nel Veronese. Nel corso del 2007, la rete ha consentito la registrazione di 516 forme d’onda relative a 28 eventi locali e regionali (di cui una decina localizzati nell’area citata) con magnitudo da 1.3 a 4.2, di cui sono stati calcolati i parametri di interesse ingegneristico. L’analisi delle registrazioni ha permesso di ricavare informazioni utili per il calcolo di scenari di scuotimento. Un esempio di taali applicazioni è rappresentato dallo scenario realizzato utilizzando come terremoto di riferimento l'evento del 24 Novembre 2004 (M 5.2)

Treatment of Hepatitis C virus genotype 3 infection with direct-acting antiviral agents

Hepatitis C virus (HCV) genotype 3 is responsible for 30.1% of chronic hepatitis C infection cases worldwide. In the era of directacting antivirals, these patients have become one of the most challenging to treat, due to fewer effective drug options, higher risk of developing cirrhosis and hepatocellular carcinoma and lower sustained virological response (SVR) rates. Currently there are 4 recommended drugs for the treatment of HCV genotype 3: pegylated interferon (PegIFN), sofosbuvir (SOF), daclatasvir (DCV) and ribavirin (RBV). Treatment with PegIFN, SOF and RBV for 12 weeks has an overall SVR rate of 83-100%, without significant differences among cirrhotic and non-cirrhotic patients. However, this therapeutic regimen has several contra-indications and can cause significant adverse events, which can reduce adherence and impair SVR rates. SOF plus RBV for 24 weeks is another treatment option, with SVR rates of 82-96% among patients without cirrhosis and 62-92% among those with cirrhosis. Finally, SOF plus DCV provides 94-97% SVR rates in non-cirrhotic patients, but 59-69% in those with cirrhosis. The addition of RBV to the regimen of SOF plus DCV increases the SVR rates in cirrhotic patients above 80%, and extending treatment to 24 weeks raises SVR to 90%. The ideal duration of therapy is still under investigation. For cirrhotic patients, the optimal duration, or even the best regimen, is still uncertain. Further studies are necessary to clarify the best regimen to treat HCV genotype 3 infection491

Use of molecular epidemiology to monitor the nosocomial dissemination of methicillin-resistant Staphylococcus aureus in a University Hospital from 1991 to 2001

Methicillin-resistant Staphylococcus aureus (MRSA) has been the cause of major outbreaks and epidemics among hospitalized patients, with high mortality and morbidity rates. We studied the genomic diversity of MRSA strains isolated from patients with nosocomial infection in a University Hospital from 1991 to 2001. The study consisted of two periods: period I, from 1991 to 1993 and period II from 1995 to 2001. DNA was typed by pulsed-field gel electrophoresis and the similarity among the MRSA strains was determined by cluster analysis. During period I, 73 strains presented five distinctive DNA profiles: A, B, C, D, and E. Profile A was the most frequent DNA pattern and was identified in 55 (75.3%) strains; three closely related and four possibly related profiles were also identified. During period II, 80 (68.8%) of 117 strains showed the same endemic profile A identified during period I, 18 (13.7%) closely related profiles and 18 (13.7%) possibly related profiles and, only one strain presented an unrelated profile. Cluster analysis showed a 96% coefficient of similarity between profile A from period I and profile A from period II, which were considered to be from the same clone. The molecular monitoring of MRSA strains permitted the determination of the clonal dissemination and the maintenance of a dominant endemic strain during a 10-year period and the presence of closely and possibly related patterns for endemic profile A. However, further studies are necessary to improve the understanding of the dissemination of the endemic profile in this hospital.1345135

Molecular Basis and Rationale for the Use of Targeted Agents and Immunotherapy in Sinonasal Cancers

Despite the progress of surgery, radiotherapy, and neoadjuvant chemotherapy, the prognosis for advanced sinonasal cancers (SNCs) remains poor. In the era of precision medicine, more research has been conducted on the molecular pathways and recurrent mutations of SNCs, with the aim of understanding carcinogenesis, helping with diagnosis, identifying prognostic factors, and finding potentially targetable mutations. In the treatment of SNC, immunotherapy is rarely used, and no targeted therapies have been approved, partly because these tumors are usually excluded from major clinical trials. Data on the efficacy of targeted agents and immune checkpoint inhibitors are scarce. Despite those issues, a tumor-agnostic treatment approach based on targeted drugs against a detected genetic mutation is growing in several settings and cancer subtypes, and could also be proposed for SNCs. Our work aims to provide an overview of the main molecular pathways altered in the different epithelial subtypes of sinonasal and skull base tumors, focusing on the possible actionable mutations for which potential target therapies are already approved in other cancer types

Hepatitis C virus in monozygotic twins

É relatado o caso de paciente grávida, com hepatite C crônica que deu à luz dois gêmeos monozigóticos. Um recém-nascido apresentou positividade para o RNA do vírus da hepatite C (RNA-VHC), no sangue venoso, coletado de veia periférica doze horas após o parto. O outro recém-nascido apresentou-se negativo para o RNA-VHC logo após o nascimento, porém tornou-se RNA-VHC positivo na amostra coletada aos três meses de idade. Os resultados permitem supor que um dos gêmeos provavelmente foi contaminado no período intra-uterino, enquanto o outro adquiriu a infecção no período perinatal. Ambos foram negativos para a presença do RNA-VHC e para os anticorpos anti-HCV em todas as amostras séricas coletadas após os nove meses de idade. Os exames laboratoriais dos gêmeos não mostraram a presença de infecção crônica pelo VHC durante o acompanhamento de 29 meses .A case of a pregnant patient with chronic hepatitis C who gave birth to monozygotic twins that were infected with HCV is reported. One of the newborns was positive for HCV-RNA in blood sample collected 12 hours after delivery. The other newborn was negative for HCV-RNA at birth, but was detected HCV viremia at three months of age. The results have led to the conclusion that one of the twins was probably contaminated in the intrauterine period, while the other acquired the infection in the perinatal period. Both were negative for HCV-RNA and for anti-HCV in the serum samples collected at nine months of age. The report describes the changes in the laboratory tests conducted in mother and twins until 29 months after delivery

DBMI04, il database delle osservazioni macrosismiche dei terremoti italiani utilizzate per la compilazione del catalogo parametrico CPTI04

This paper describes the main features of the Macroseismic Database of Italy 2004, which for the first time put together in a critical way the macroseismic data used for the compilation of the CPTI04 (2004) parametric earthquake catalogue. Data come from varied main datasets: i) DOM4.1 (Monachesi e Stucchi, 1997); ii) CFTI version 2 (Boschi et al., 1997) and, for the time-window 1980-2002, CFTI version 3 (Boschi et al., 2000); iii) Bollettino Macrosismico ING (BMING); iv) Catalogo Macrosismico dei Terremoti Etnei, Azzaro et al. (2000; 2002). In addition, data from recent historical and field investigation were also used. DBMI04 contains 58146 macroseismic observations related to 1041 earthquakes and 14161 localities, 12943 of which in Italy. The input data used for the compilation of DBMI04 were not homogeneous with respect to the use of the intensity scale and, mainly, to geographical reference. One of the main task was the organisation of a reliable geographical reference, based on the previous ENEL-ISTAT catalogue of the Italian localities (ENEL, 1978), which was updated by means of new data. Another task consisted in correcting some mistakes performed when associating the placenames quoted by the historical sources and the geographical reference. Some problems were solved using ad hoc conventions for dealing with observations not expressed in terms of macroseismic intensity. This paper presents the adopted solutions and the results, together with the web-interface through which the database is made available to the public (http://emidius.mi.ingv.it/DBMI04/)