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| LETTER TO THE EDITOR |
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| Year : 2022 | Volume
: 19
| Issue : 2 | Page : 124-125 |
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Corticosteroids are high-potency drugs and should be used judiciously
Harish Gupta1, Nitu Nigam2, Sudhir Kumar Verma1, Ajay Kumar Patwa3
1 Department of Medicine, KG's Medical University, Lucknow, Uttar Pradesh, India
2 Cytogenetics Unit, KG's Medical University, Lucknow, Uttar Pradesh, India
3 Med Gastroenterology Unit, KG's Medical University, Lucknow, Uttar Pradesh, India
| Date of Submission | 20-Sep-2021 |
| Date of Decision | 30-Sep-2021 |
| Date of Acceptance | 01-Oct-2021 |
| Date of Web Publication | 11-Apr-2022 |
Correspondence Address:
Harish Gupta
Department of Medicine, KG's Medical University, Lucknow - 226 003, Uttar Pradesh
India
 Source of Support: None, Conflict of Interest: None
DOI: 10.4103/am.am_105_21
How to cite this article:
Gupta H, Nigam N, Verma SK, Patwa AK. Corticosteroids are high-potency drugs and should be used judiciously. Apollo Med 2022;19:124-5 |
“Life is short, art long, opportunity fleeting, experience treacherous, judgement difficult.”
– Hippocrates c. 460–377 BC, Greek Physician
To the Editor,
Swain and Pani assess the role of corticosteroids and olfactory training in treating post-COVID-19 olfactory dysfunction in their original article published on August 30, 2021, in the Journal. Findings of the study are summarized. As per these tables, although they state that they studied post-COVID-19 patients, there is no gap between having the disease and their follow-up observations.[1]
Although at present there is no universal definition of post-COVID-19 dysfunction, i.e., when does it occur, neither is there universally recognized terminology; some consensus appears that 4 weeks after an acute episode, postacute complications emerge.[2] As still the pandemic is evolving, its shape and size are changing on a regular basis with emergence of new variants; there is a lot of speculation about our common future and our knowledge needs to be updated and shared on a constant basis. However, what is an accepted fact is that during acute episode what we observe is acute manifestation and what happens subsequently is post- or sub-acute phenomenon. Therefore, by this convention post Covid dysfunction should occur 'after' acute phase.[3] In this respect, what we observe in the present study is a continuum of acute phase during home isolation or hospital treatment and then postacute care. Therefore, the complication of interest is not clearly a case of post-COVID-19 dysfunction and lies at the margin of somewhere between acute versus subacute stage.
As the author excluded diabetics and hypertensives from the study, how much representative is this study of an average cohort, we wonder. As per our experience in COVID hospital, this population forms a majority in indoors,[4] and if excluded – genuinely due to coexistence of neuropathy – the results may have limited utility.[5]
RECOVERY Trial affirmed beneficial effects of corticosteroids only in severely ill patients,[4],[6] and authors state this point in Introduction as well as Discussion of the study. Still, they give it to those patients who are in home isolation – which are not severely ill. Moreover, among the hospitalized patients how many are severe, we need to discover. As making any decision in Medicine, we need to carefully weigh benefits versus risks/adverse effects of any medical intervention/drug to find out if that is indicated in a given situation to a specific patient. That decision-making process needs to be reemphasized and elaborated.
In the aftermath of the second wave in April-May 2021, we witnessed a wave of mucormycosis in our hospital and elsewhere immediately thereafter.[7],[8] Some authors believe that to be due to overuse of corticosteroids along with several other factors. Hence, to avoid any iatrogenic distortion, we ought to demonstrate that a high-potency drug like this immunosuppressant is used with judiciousness and utmost care and consideration of all the aspects of its pharmacology. In lieu of that reasoning, we may find ourselves making incorrect decisions.
Author reply: corticosteroids are high potency drugs and should be used judiciously
To the Editor,
Thanks for getting the comments/Letter to editor for our article. Thanks for their appropriate opinion in respect to COVID-19 infections and use of steroid resulting COVID-19-associated mucormycosis (CAM). Hyposmia and anosmia are morbid and sensitive clinical issues of the COVID-19 patients. The use of steroid is thought to be the predisposing factor for CAM. However, we found that there are several number of CAM patients without the use of corticosteroids. Corticosteroids are not considered as only and established cause for CAM. In our study, no single patient those administered with topical steroids and short course of steroid were not developed CAM. However, we should be cautious regarding the use of steroid along with eliminating a sensitive and morbid clinical entity like anosmia/hyposima in post-COVID/COVID-19 patients during our clinical practice.
With kind regards
Address for correspondence: Dr. Santosh Kumar Swain,
Department of Otorhinolaryngology and Head and Neck Surgery, IMS
and SUM Hospital, Siksha “O” Anusandhan University, K8, Kalinga Nagar,
Bhubaneswar 751 003, Odisha, India.
Email: [email protected]
Financial support and sponsorship
Nil.
Conflicts of interest
There are no conflicts of interest.
| References | |  |
| 1. | Swain SK, Pani SR. Role of oral corticosteroid and olfactory training for treatment of Post-COVID-19 olfactory dysfunction: Our experiences. Apollo Med 2021;18:162-5.  [Full text] |
| 2. | Nalbandian A, Sehgal K, Gupta A, Madhavan MV, McGroder C, Stevens JS, et al. Post-acute COVID-19 syndrome. Nat Med 2021;27:601-15. |
| 3. | |
| 4. | Berlin DA, Gulick RM, Martinez FJ. Severe COVID-19. N Engl J Med 2020;383:2451-60. |
| 5. | Yazla S, Özmen S, Kıyıcı S, Yıldız D, Haksever M, Gencay S. Evaluation of olfaction and taste function in type 2 diabetic patients with and without peripheral neuropathy. Diabetes Metab Res Rev. 2018;34. doi: 10.1002/dmrr.2973. Epub 2018 Jan 11. PMID: 29232497. |
| 6. | RECOVERY Collaborative Group; Horby P, Lim WS, Emberson JR, Mafham M, Bell JL, et al. Dexamethasone in hospitalized patients with COVID-19. N Engl J Med 2021;384:693-704. |
| 7. | Selarka L, Sharma S, Saini D, Sharma S, Batra A, Waghmare VT, et al. Mucormycosis and COVID-19: An epidemic within a pandemic in India. Mycoses 2021;64:1253-60. |
| 8. | Banerjee I, Robinson J, Asim M, Sathian B, Banerjee I. Mucormycosis and COVID-19 an epidemic in a pandemic? Nepal J Epidemiol 2021;11:1034-9. |
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