Objectives: This study aimed to assess potential associations between self-reported symptoms of laryngopharyngeal reflux (LPR) and voice disorders among two undiagnosed cohorts in Saudi Arabia. Methods: This cross-sectional study was conducted from February to April 2017 in Khobar, Saudi Arabia. Validated Arabic versions of the Reflux Symptom Index (RSI) and 10-item Voice Handicap Index (VHI-10) were distributed to 400 teachers at 13 schools and 300 members of the general population attending an ear, nose and throat clinic in Khobar. Scores of >13 and >11 on the RSI and VHI-10 indicated a potential subjective diagnosis of LPR and voice disorders, respectively. Results: A total of 446 individuals took part in the study, including 260 members of the general population (response rate: 86.7%) and 186 teachers (response rate: 46.5%). The mean age was 32.5 years. In total, 62.2% complained of voice and/or reflux problems, with the remaining 37.8% not reporting/unaware of any problems in this regard. Among the teachers, 30.6% and 18.3% had positive RSI and VHI-10 scores, respectively, while 43.1% and 14.6% of the individuals from the general population had positive RSI and VHI-10 scores, respectively. Overall, VHI-10 scores were significantly associated with RSI scores (P <0.001). Conclusion: A significant association between RSI and VHI-10 scores suggests that there may be an association between LPR and voice disorders. These tools would therefore be a valuable method of monitoring patients; however, they cannot be used to confirm a diagnosis. Thus, more detailed studies are needed to confirm this association using a larger sample size.Keywords: Voice Disorders; Laryngopharyngeal Reflux; Hoarseness; Diagnostic Self Evaluation; School Teachers; Saudi Arabia.

BACKGROUND AND OBJECTIVESConsumption of energy drinks has adverse effects on the heart that might be potentiated in obese individuals. Since the incidence of obesity and use of energy drinks is high among Saudi youth, we used non-invasive tests to study hemodynamic changes produced by altered autonomic cardiac activity following consumption of energy drinks in obese male students.DESIGN AND SETTINGThis cross-sectional study was carried out at Department of Physiology, College of Medicine, University of Dammam, Saudi Arabia, over a one-year period from December 2013 to December 2014.SUBJECTS AND METHODSIn Saudi male university students we measured continuous ECG recordings and a one-minute deep breathing maneuver to measure the expiratory-to-inspiratory ratio, the mean heart rate range (MHRR), the mean percentage variability. (M%VHR) and the corrected QT interval (QTc) at 0, 30 and 60 minutes after consumption of energy drink.RESULTSWe enrolled 31 students (18 overweight/obese and 13 normal weights. QTc was significantly increased at 60 min as compared with the resting state in overweight/obese subjects (P=.006). Heart rate variability was significantly less in obese as compared with normal weight subjects at 60 minutes as indicated by E:I ratio, (P=.037), MHRR (P=.012), M%VHR (P=.040) after energy drink consumption. Significant increases in diastolic (P= .020) and mean arterial blood pressure (P=.024) were observed at 30 minutes in the obese group.CONCLUSIONHemodynamic changes after intake of energy drinks in obese subjects indicate that obesity and energy drinks could synergistically induce harmful effects. This finding warrants efforts to caution the obese on intake of energy drinks and timely intervention to motivate changes in life style.

Objective Physicians on the frontline of the COVID‐19 pandemic are at increased risk of contracting the disease. Otolaryngologists are amongst the high‐risk practitioners, as they are in close proximity to patient's upper airway, which may induce their psychological stress. Methods A cross‐sectional survey study, conducted among otolaryngologists in Saudi Arabia from June 11 to June 22. Survey consisted of sociodemographic questionnaire, Coronavirus Anxiety Scale (CAS), Obsession with COVID‐19 Scale (OCS) and Patient Health Questionnaire‐9 (PHQ‐9). Available otolaryngologists with no history of mental health problems were included. A P‐value lower than .05 was considered statistically significant. Results The study included 129 participants; 63.6% men and 36.4% women. 81.4% of participants were living with family, 57.4% living with either a child or an elderly family member. Nearly 7.8% of participants had dysfunctional COVID‐19 anxiety and 75.2% had COVID‐19‐related depression symptoms ranging from minimal to severe. Obsession and dysfunctional thinking regarding COVID‐19 were found in 26.4% of participants. Single otolaryngologists had significantly higher CAS (P = .025), OCS (P = .048), and PHQ‐9 (P < .001) scores. Participants who lived with children or elderly individuals had significantly higher OCS scores (P = .005). When comparing job ranks, residents had significantly higher scores for the CAS (P = .016) and PHQ‐9 (P < .001). Conclusion COVID‐19 has a considerable psychological impact on otolaryngologists. Specifically, the young and single who have less social support. This indicates the importance of psychological support to this group. Additional thorough studies should explore the psychological impact of COVID‐19 in this field as it may carry devastating long‐term consequences if left unattended. Level of evidence Level 4.

BACKGROUNDObesity and caffeine consumption may lead to autonomic disturbances that can result in a wide range of cardiovascular disorders.OBJECTIVESTo determine autonomic disturbances produced by the synergistic effects of overweight or obesity (OW/OB) and energy drinks.DESIGNCross-sectional, analytical.SETTINGPhysiology department at a university in Saudi Arabia.SUBJECTS AND METHODSUniversity students, 18–22 years of age, of normal weight (NW) and OW/OB were recruited by convenience sampling. Autonomic testing by the Valsalva ratio (VR) along with systolic and diastolic blood pressure, pulse pressure, and mean arterial blood pressure were measured at baseline (0 minute) and 60 minutes after energy drink consumption.MAIN OUTCOME MEASURE(S)Autonomic disturbance, hemodynamic changes.RESULTSIn 50 (27 males and 23 females) subjects, 21 NW and 29 OW/OB, a significant decrease in VR was observed in OW/OB subjects and in NW and OW/OB females at 60 minutes after energy drink consumption. Values of systolic and diastolic blood pressure, pulse pressure and mean arterial blood pressure were also significantly higher in OW/OB and in females as compared to NW and males. BMI was negatively correlated with VR and diastolic blood pressure at 60 minutes.CONCLUSIONObesity and energy drinks alter autonomic functions. In some individuals, OW/OB may augment these effects.LIMITATIONSDue to time and resource restraints, only the acute effects of energy drinks were examined.