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Summary: In healthcare, fabric or metal-bead lanyards are universally used for carrying identity cards. However there is little information on microbial contamination with potential pathogens that may readily re-contaminate disinfected hands. We examined 108 lanyards from hospital staff. Most grew skin flora but 7/108 (6%) had potentially pathogenic bacteria: four grew methicillin-susceptible Staphylococcus aureus, and four grew probable fecal flora: 3 Clostridium perfringens and 1 Clostridium bifermentans (one lanyard grew both S. aureus and C. bifermentans). Unused (control) lanyards had little or no such contamination. The median duration of lanyard wear was 12 months (interquartile range 3–36 months). 17/108 (16%) of the lanyards had reportedly undergone decontamination including wiping with alcohol, chlorhexidine or chlorine dioxide; and washing with soap and water or by washing machine. Metal-bead lanyards had significantly lower median bacterial counts than those from fabric lanyards (1 vs. 4 CFU/cm2; Mann–Whitney U = 300.5; P

We recently encountered three patients with episodes of syncope associated with food ingestion. A 31-year-old woman had an episode of syncope in the hospital while drinking soda. Transient asystole was noted on the telemonitor, confirming the diagnosis of swallow syncope. The other two patients were 78- and 80 year old gentlemen, respectively, who presented with recurrent and transient episodes of dizziness during deglutition. Extensive work-up of syncope was negative in both cases and a diagnosis of swallow syncope was made by clinical criteria. These cases illustrate the challenging problem of swallow syncope. The diagnosis can be suspected on the basis of clinical presentation and confirmed with the demonstration of transient brady-arrhythmia during deglutition. Medical management includes avoiding trigger foods, use of anticholinergics, and/or placement of a permanent cardiac pacemaker.