Shingola G

À l’hôpital Tenon de l’AP-HP ce matin pour lancer la campagne de vaccination contre la grippe et le Covid-19. La vaccination reste notre meilleure protection, notamment pour les personnes les plus fragiles. Cette année, nous facilitons l’accès à la vaccination en permettant aux médecins, infirmiers et sages-femmes de disposer de stocks de vaccins contre la grippe et le Covid-19 pour vacciner plus facilement leurs patients. Le PLFSS 2027 prévoit également de nouvelles mesures pour améliorer l’accès à la vaccination et renforcer la couverture vaccinale, notamment dans les établissements de santé et les EHPAD. Nous engageons enfin une première étape vers la vaccination obligatoire contre la grippe pour les professionnels concernés, afin de mieux protéger les patients les plus vulnérables.

Endocrine complications of COVID-19: diabetes, musculoskeletal, thyroid, pituitary, adrenal, and gonadal disorders 🚨COVID can trigger new diabetes, crash calcium, inflame the thyroid, and suppress testosterone or cortisol. Benefits of vaccination still dwarf the rare endocrine side-effects, says a 2026 Endocrine Society review. ➡️The USA review synthesizes English-language reviews and meta-analyses from March 2020 to June 2026 on endocrine effects of acute SARSCoV2. ➡️SARSCoV2 enters cells via ACE2, aided by TMPRSS2 and ADAM17. Damage occurs through direct invasion, cytokine release, autoimmunity, and medication effects, hitting pancreas, thyroid, pituitary, adrenals, gonads, and parathyroid/bone. ➡️1. Pancreas. - New-onset diabetes rises after infection (relative risk 1.41 in a 12-study meta-analysis, about 1.37% prevalence in a 43-study review of 4.4 million patients, mostly type 2), - Diabetic ketoacidosis and severe outcomes increase, especially in type 1 diabetes, - Risk peaks in the first year and varies with severity, variant, age, and comorbidities, - Metformin and DPP-4 inhibitors are noted as potentially protective, ➡️2. Thyroid: - Non-thyroidal illness syndrome is the commonest change (pooled prevalence about 26%), - Subacute thyroiditis and new autoimmune hypo- or hyperthyroidism also occur and track with severity (odds ratio 3.77 for abnormal tests in severe versus milder disease), - Dysfunction can persist into longC0VID, ➡️3. Pituitary: - Reported effects include hypophysitis, apoplexy, SIADH, rare central diabetes insipidus, and hypopituitarism (secondary adrenal insufficiency or hypogonadism), mainly after severe illness, via hypoxia, thrombosis, or inflammation, ➡️4. Adrenals: - Adrenal insufficiency appears in roughly 3.5–6.8% of mild and 7–38.5% of severe cases, mostly central and often reversible. - Primary failure is rare (haemorrhage, infarction, or adrenalitis). ➡️5. Gonads: - Low total testosterone with normal LH, reduced libido, and erectile dysfunction are described, especially in longC0VID, - Permanent infertility is not established, - Higher male severity is not fully explained by androgens, ➡️6. Parathyroid/bone: - Hypocalcaemia occurs in about 55% (range 23–78%, up to 87% by ionized calcium) and tracks with severity and mortality, - Mechanisms include parathyroid invasion, vitamin D deficiency, and calcium use during viral entry, - Remodelling shifts toward more osteoclasts, lower bone density, and higher vertebral-fracture risk, - Hypercalcemia is rare. ➡️Most selected studies are non-randomized and heterogeneous. ‼️So, AGAIN, any tissue expressing ACE2 can be injured by SARSCoV2, so the largest absolute endocrine burden falls on the millions with mild-to-moderate infection rather than only the critically ill! ‼️Mild COVID-19 is not trivial for the endocrine system. The review notes that while severe infection produces the starkest individual complications, the largest overall burden falls on the far larger group with mild-to-moderate illness. Unexplained fatigue, rising blood sugar, neck pain, muscle weakness, low libido, or menstrual change after even a mild case therefore justify checking glucose or HbA1c, TSH, and calcium—and, when symptoms point that way, morning cortisol or testosterone, rather than dismissing them as ordinary post-viral tiredness. People who already have diabetes or adrenal insufficiency still need tighter sick-day attention, because a “mild” infection can unmask or worsen those conditions! #AvoidSars #AvoidReinfections academic.oup.com/jes/article…

(around 4000ppm sometimes), and nothing substantive is being done to change that. The 2022 election promise by E.Macron to undertake a massive effort to ensure clean air in every public place (schools, healthcare...) before the end of the (2022) year leparisien.fr/societe/purifi… 2/13