No new trials were found for inclusion in this update. Four studies involving 1943 participants with acute sinusitis met our inclusion criteria. The trials were well-designed and double-blind and studied INCS versus placebo or no intervention for 15 or 21 days. The rates of loss to follow-up were 7%, 11%, 41% and 10%. When we combined the results from the three trials included in the meta-analysis, participants receiving INCS were more likely to experience resolution or improvement in symptoms than those receiving placebo (73% versus %; risk ratio (RR) ; 95% confidence interval (CI) to ). Higher doses of INCS had a stronger effect on improvement of symptoms or complete relief: for mometasone furoate 400 µg versus 200 µg (RR ; 95% CI to versus RR ; 95% CI to ). No significant adverse events were reported and there was no significant difference in the drop-out and recurrence rates for the two treatment groups and for groups receiving higher doses of INCS.
As a glucocorticoid , the lipophilic structure of prednisolone allows for easy passage through the cell membrane where it then binds to its respective glucocorticoid receptor (GCR) located in the cytoplasm. Upon binding, formation of the GC/GCR complex causes dissociation of chaperone proteins from the glucocorticoid receptor enabling the GC/GCR complex to translocate inside the nucleus. This process occurs within 20 minutes of binding. Once inside the nucleus, the homodimer GC/GCR complex binds to specific DNA binding-sites known as glucocorticoid response elements (GREs) resulting in gene expression or inhibition. Complex binding to positive GREs leads to synthesis of anti-inflammatory proteins while binding to negative GREs block the transcription of inflammatory genes. 
As a non-aromatizing androgen, dihydrotestosterone is extremely potent. Aromatization refers to the conversion of testosterone or anabolic steroids into estrogen. High estrogenic activity causes bloating, acne, water retention and oily skin. As dihydrotestosterone does not aromatize even at high dosages, users do not face the aforementioned side-effects. Lack of water retention also has a hardening effect on muscle tissue, in bodybuilders. Being a powerful androgen, dihydrotestosterone is also responsible for a shift in the estrogen-testosterone ratio in the body. Due to its predominant androgenic component, the steroid has a stimulating effect on the adreno-pituitary functions, and causes neurological excitation in the ‘sexual orientation areas of the brain’. This in turn, spikes sex drive in males.