Background: The recent emergence of a novel coronavirus (SARS-CoV-2) has caused serious public health concerns due to its rapid dissemination worldwide. A total of 8,931 positive cases had been reported in Morocco by the 16th of June 2020. Methods: To better understand the SARS-CoV-2 pandemic in this North African country, we analyzed the complete genome sequences of the virus related to Morocco by constructing a phylogenetic tree and creating a variant network using the available Moroccan and other sequences in dedicated databases. Results: Phylogenetic and variant network analyses of SARS-CoV-2 strains from early patients with COVID-19 in Morocco showed multiple spatiotemporal introductions from Italy (ten), France (seven), Spain (one) and Portugal (one). This is consistent with the assumption that the early infections in Morocco were imported, mainly from Europe. The 17 virus strains form two independent phylogenetic clusters and provide evidence for early community-based transmission following the initial introductions of the virus. We then catalogued 13 novel mutations in the SARS-CoV-2 isolates from Moroccan patients. Interestingly, the recurrent missense variant A>G at position 23,403 in the spike gene, known to be associated with virus severity, has been identified in all Moroccan isolates. Conclusions: These primary findings testify of the importance of the genomic surveillance strategies as a means of understanding the virus spread dynamics, counteracting the pandemic outbreak, and drawing useful lessons for dealing with any future emerging infectious pathogens.
Severe left ventricular dysfunction increases the surgical risk of aortic valve replacement on aortic valvular stenosis. Several risk factors of hospital mortality have been reported in heterogeneous series. The aim of this study was to identify mortality risk factors of aortic valve replacement in patients with severe aortic stenosis and severe left ventricular dysfunction. To avoid biases of associated diseases, our study has been focused on isolated aortic stenosis. 46 patients, with AS and severe left ventricular dysfunction who underwent AVR were enrolled in this retrospective study. The mean age was 59 ± 12.70 years. 69.6% of patients were in class III or IV NYHA. The mean left ventricular ejection fraction (LVEF) was 32.3 ± 5.3%, and the mean EuroSCORE was 12.20 ± 8.70. The hospital mortality was 15.20%. The morbidity was marked mainly by low output syndrome in 30.4% of cases. A logistic regression in univariate analysis reveals functional class, renal failure, congestive heart failure and LVEF as factors related to the risk of hospital mortality. Multivariate logistic regression analysis found renal failure (OR = 11.94, CI [2.65 -72.22], p = 0.03) and congestive heart failure (OR = 25.33, CI [3 43 -194.74], p = 0.009) as independents risk of hospital mortality. The mean follow-up was 59.6 ± 21 months. Late mortality was 5%. Congestive heart failure and preoperative renal failure are the main independents hospital mortality’s risk factors of aortic valve replacement in patients with severe aortic stenosis and severe left ventricular dysfunction. Late mortality might be inversely related to the LV recovery.
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