Corticosteroids are used therapeutically for a broad spectrum of diseases including autoimmune, allergic and inflammatory diseases. However in trials, the evidence for using corticosteroids in dengue is inconclusive and the quality of evidence is low. This systemic review is conducted to review clinical trials on dengue and steroid therapy to identify the current strength and weakness of evidence for the use of corticosteroids.We searched MEDLINE/PUBMED and Google scholar for publications on steroid use in dengue and the relevant authors of the study were contacted for additional information, as required. This review includes thirteen studies enrolling 1293 children and adult participants. There was no evidence of viremia and no significant side effects after the administration of low and high doses of oral corticosteroids and high doses of intravenous corticosteroids. Beneficial therapeutic effects were seen in some studies, which used high doses or multiple doses of steroids.The effectiveness of corticosteroids in dengue is depended upon sustained therapeutic blood levels of corticosteroids for an adequate duration and using a steroid with higher receptor affinity. Further clinical trials using pharmacologically and immunologically accepted standard steroid protocols are warranted to validate this conclusion.

BackgroundMigraine is a primary headache disorder, which cause significant disability in adolescence. This double blind, randomized clinical trial assessed the immediate effects of suction of paranasal sinus air during an acute migraine episode.MethodsA randomized, double blind study was conducted with 56 selected Sri Lankan school children of 16–19 years of age. Participants who met International Headache Society criteria for migraine (with or without aura) were included in the study. Subjects were randomly allocated into 2 groups where one group was subjected to three intermittent 10 sec paranasal air suctions with a ten sec suction free interval between two suctions for each nostril and the other group was subjected to placebo air suction (no paranasal air suction) in similar arrangement. Severity of headache and sub–orbital tenderness before and after suction were recorded using standard pain rating scale.ResultsAfter dropouts, treated and placebo groups consisted of 27 and 23 subjects respectively. The mean headache pain score drop in the treated group was significantly higher compared to that of the control group. Moreover, there was a difference in the treatment response between the types of headache (with or without aura). With respect to tenderness there was a statistically significant drop in the treated group compared to the control. In general, airflow rates in left and right nostrils were different in these subjects. However such difference was not seen in the tenderness on two sides. Nevertheless it was revealed that airflow rate has a slight negative correlation with the tenderness irrespective of the side.ConclusionSixty–second paranasal air suction can provide an immediate pain relief for acute migraine in adolescents. We did not assess pain outcomes beyond 60 s, but the initial responses suggests the need to further study the efficacy of paranasal suction in migraine. A further study is suggested to evaluate the acute effects, efficacy and side effects of paranasal air suction using follow up over a prolong period.Trial registrationSri Lanka Clinical Trials Registry SLCTR/2017/018, 29 Jun 2017. Retrospectively registered.

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Introduction: Dengue infection causes significant morbidity and mortality in over 125 countries worldwide, and its incidence is on the rise. Currently, no therapy is available beyond supportive care. In fact, corticosteroids are used therapeutically for a broad spectrum of diseases including autoimmune, allergic, inflammatory diseases and organ transplant rejection. However, only a few studies were done to evaluate the effectiveness of corticosteroids in dengue infection, although the immune pathology of dengue is similar to other diseases treated effectively by corticosteroids for several decades. Objectives: This review is aimed at identifying biological actions of steroids at molecular and receptor level in dengue immune pathology after reviewing pharmacological and immunological research findings of corticosteroids and dengue. Methods: We searched medline/pubmed and Google scholar for publications with the search terms 'dengue' and 'steroid', 'corticosteroid', 'prednisolone', 'methylprednisolone' or 'dexamethasone' in the title and abstract. Then the publications were analyzed according the action of steroids in dengue pathology under different subheadings. Results: The results are presented under four categories and it shows that corticosteroids can suppress cells involved in innate immunity, T cells, B cells and antibodies,complements and heamatological manifestations in dengue pathology. Conclusion:This article explains strong supportive evidence for actions of corticosteroids in dengue pathology at receptors and molecular levels. Therefore it is suggested that a gold standard steroid protocol for each phase of dengue pathology that can be tested further with a double blind control trial study.

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