June 25, 2018, 1:27 pm
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1 Philippine Peso = 0.06901 UAE Dirham
1 Philippine Peso = 2.02912 Albanian Lek
1 Philippine Peso = 0.03401 Neth Antilles Guilder
1 Philippine Peso = 0.5072 Argentine Peso
1 Philippine Peso = 0.02524 Australian Dollar
1 Philippine Peso = 0.03345 Aruba Florin
1 Philippine Peso = 0.03758 Barbados Dollar
1 Philippine Peso = 1.57159 Bangladesh Taka
1 Philippine Peso = 0.03155 Bulgarian Lev
1 Philippine Peso = 0.00712 Bahraini Dinar
1 Philippine Peso = 32.90079 Burundi Franc
1 Philippine Peso = 0.01879 Bermuda Dollar
1 Philippine Peso = 0.02526 Brunei Dollar
1 Philippine Peso = 0.1289 Bolivian Boliviano
1 Philippine Peso = 0.07111 Brazilian Real
1 Philippine Peso = 0.01879 Bahamian Dollar
1 Philippine Peso = 1.28053 Bhutan Ngultrum
1 Philippine Peso = 0.19402 Botswana Pula
1 Philippine Peso = 376.17437 Belarus Ruble
1 Philippine Peso = 0.03754 Belize Dollar
1 Philippine Peso = 0.02493 Canadian Dollar
1 Philippine Peso = 0.01856 Swiss Franc
1 Philippine Peso = 11.99061 Chilean Peso
1 Philippine Peso = 0.12218 Chinese Yuan
1 Philippine Peso = 54.75385 Colombian Peso
1 Philippine Peso = 10.57591 Costa Rica Colon
1 Philippine Peso = 0.01879 Cuban Peso
1 Philippine Peso = 1.77772 Cape Verde Escudo
1 Philippine Peso = 0.41526 Czech Koruna
1 Philippine Peso = 3.33615 Djibouti Franc
1 Philippine Peso = 0.12016 Danish Krone
1 Philippine Peso = 0.92728 Dominican Peso
1 Philippine Peso = 2.1963 Algerian Dinar
1 Philippine Peso = 0.25225 Estonian Kroon
1 Philippine Peso = 0.33484 Egyptian Pound
1 Philippine Peso = 0.51146 Ethiopian Birr
1 Philippine Peso = 0.01612 Euro
1 Philippine Peso = 0.03918 Fiji Dollar
1 Philippine Peso = 0.01416 Falkland Islands Pound
1 Philippine Peso = 0.01417 British Pound
1 Philippine Peso = 0.08979 Ghanaian Cedi
1 Philippine Peso = 0.87956 Gambian Dalasi
1 Philippine Peso = 169.07178 Guinea Franc
1 Philippine Peso = 0.14072 Guatemala Quetzal
1 Philippine Peso = 3.87599 Guyana Dollar
1 Philippine Peso = 0.14741 Hong Kong Dollar
1 Philippine Peso = 0.44878 Honduras Lempira
1 Philippine Peso = 0.11882 Croatian Kuna
1 Philippine Peso = 1.24803 Haiti Gourde
1 Philippine Peso = 5.23224 Hungarian Forint
1 Philippine Peso = 264.43067 Indonesian Rupiah
1 Philippine Peso = 0.06764 Israeli Shekel
1 Philippine Peso = 1.27568 Indian Rupee
1 Philippine Peso = 22.24728 Iraqi Dinar
1 Philippine Peso = 798.38407 Iran Rial
1 Philippine Peso = 2.03119 Iceland Krona
1 Philippine Peso = 2.45509 Jamaican Dollar
1 Philippine Peso = 0.01333 Jordanian Dinar
1 Philippine Peso = 2.06417 Japanese Yen
1 Philippine Peso = 1.89121 Kenyan Shilling
1 Philippine Peso = 1.28183 Kyrgyzstan Som
1 Philippine Peso = 76.00526 Cambodia Riel
1 Philippine Peso = 7.92522 Comoros Franc
1 Philippine Peso = 16.91094 North Korean Won
1 Philippine Peso = 20.86622 Korean Won
1 Philippine Peso = 0.00568 Kuwaiti Dinar
1 Philippine Peso = 0.01541 Cayman Islands Dollar
1 Philippine Peso = 6.38595 Kazakhstan Tenge
1 Philippine Peso = 158.00451 Lao Kip
1 Philippine Peso = 28.292 Lebanese Pound
1 Philippine Peso = 2.98572 Sri Lanka Rupee
1 Philippine Peso = 2.74709 Liberian Dollar
1 Philippine Peso = 0.25254 Lesotho Loti
1 Philippine Peso = 0.05728 Lithuanian Lita
1 Philippine Peso = 0.01166 Latvian Lat
1 Philippine Peso = 0.02548 Libyan Dinar
1 Philippine Peso = 0.1786 Moroccan Dirham
1 Philippine Peso = 0.3177 Moldovan Leu
1 Philippine Peso = 0.98891 Macedonian Denar
1 Philippine Peso = 25.98647 Myanmar Kyat
1 Philippine Peso = 45.97896 Mongolian Tugrik
1 Philippine Peso = 0.15183 Macau Pataca
1 Philippine Peso = 6.67042 Mauritania Ougulya
1 Philippine Peso = 0.65295 Mauritius Rupee
1 Philippine Peso = 0.29256 Maldives Rufiyaa
1 Philippine Peso = 13.4053 Malawi Kwacha
1 Philippine Peso = 0.37584 Mexican Peso
1 Philippine Peso = 0.07518 Malaysian Ringgit
1 Philippine Peso = 0.25239 Namibian Dollar
1 Philippine Peso = 6.72679 Nigerian Naira
1 Philippine Peso = 0.59207 Nicaragua Cordoba
1 Philippine Peso = 0.15205 Norwegian Krone
1 Philippine Peso = 2.03401 Nepalese Rupee
1 Philippine Peso = 0.02719 New Zealand Dollar
1 Philippine Peso = 0.00723 Omani Rial
1 Philippine Peso = 0.01879 Panama Balboa
1 Philippine Peso = 0.06134 Peruvian Nuevo Sol
1 Philippine Peso = 0.0609 Papua New Guinea Kina
1 Philippine Peso = 1 Philippine Peso
1 Philippine Peso = 2.28222 Pakistani Rupee
1 Philippine Peso = 0.06966 Polish Zloty
1 Philippine Peso = 106.55769 Paraguayan Guarani
1 Philippine Peso = 0.06839 Qatar Rial
1 Philippine Peso = 0.07509 Romanian New Leu
1 Philippine Peso = 1.18236 Russian Rouble
1 Philippine Peso = 15.96073 Rwanda Franc
1 Philippine Peso = 0.07046 Saudi Arabian Riyal
1 Philippine Peso = 0.1479 Solomon Islands Dollar
1 Philippine Peso = 0.25235 Seychelles Rupee
1 Philippine Peso = 0.33738 Sudanese Pound
1 Philippine Peso = 0.16635 Swedish Krona
1 Philippine Peso = 0.02551 Singapore Dollar
1 Philippine Peso = 0.01417 St Helena Pound
1 Philippine Peso = 0.41725 Slovak Koruna
1 Philippine Peso = 149.94363 Sierra Leone Leone
1 Philippine Peso = 10.72905 Somali Shilling
1 Philippine Peso = 394.98309 Sao Tome Dobra
1 Philippine Peso = 0.16441 El Salvador Colon
1 Philippine Peso = 9.67644 Syrian Pound
1 Philippine Peso = 0.25202 Swaziland Lilageni
1 Philippine Peso = 0.61856 Thai Baht
1 Philippine Peso = 0.04882 Tunisian Dinar
1 Philippine Peso = 0.04333 Tongan paʻanga
1 Philippine Peso = 0.08786 Turkish Lira
1 Philippine Peso = 0.12682 Trinidad Tobago Dollar
1 Philippine Peso = 0.56924 Taiwan Dollar
1 Philippine Peso = 42.63435 Tanzanian Shilling
1 Philippine Peso = 0.49267 Ukraine Hryvnia
1 Philippine Peso = 72.51597 Ugandan Shilling
1 Philippine Peso = 0.01879 United States Dollar
1 Philippine Peso = 0.59451 Uruguayan New Peso
1 Philippine Peso = 147.50094 Uzbekistan Sum
1 Philippine Peso = 1499.4363 Venezuelan Bolivar
1 Philippine Peso = 430.10147 Vietnam Dong
1 Philippine Peso = 2.07159 Vanuatu Vatu
1 Philippine Peso = 0.0488 Samoa Tala
1 Philippine Peso = 10.56614 CFA Franc (BEAC)
1 Philippine Peso = 0.05073 East Caribbean Dollar
1 Philippine Peso = 10.56614 CFA Franc (BCEAO)
1 Philippine Peso = 1.92165 Pacific Franc
1 Philippine Peso = 4.69466 Yemen Riyal
1 Philippine Peso = 0.25241 South African Rand
1 Philippine Peso = 97.51033 Zambian Kwacha
1 Philippine Peso = 6.80008 Zimbabwe dollar

Antibiotic Stewardship

At the 103rd Annual Clinical Congress of the American College of Surgeons last week in San Diego, California, I met several surgeons from the Philippines who flew in to attend the ACS Congress. As a Fil-Am surgeon, I always enjoy and savor meeting my colleagues from my native land. One of them happened to be an old friend, Dr. Enrique T. Ona, former Secretary of Health of the Philippines. This yearly continuing surgical education event attracts hundreds of surgeons from all over the world.

One of the hot topics at this international convention was Antibiotic Stewardship, a vital global program ACS is spearheading that could save humanity as a whole from deadly superbugs that could wipe out civilization, if not prevented or contained, an issue I have discussed in a previous column.

According to the World Health Organization, “antibiotic resistance is one of the major threats to human health, especially because some bacteria have developed resistance to all known classes of antibiotics.”

Improper use
The United States Centers for Disease Control and Prevention (CDC) reported that “30 percent to 50 percent of prescribed antibiotics in hospitals are administered in settings where an antibiotic is unnecessary or is ineffective against the pathogenic organisms…. Increased and inappropriate antibiotic use leads to increased risks of antibiotic resistance, as well as contributing to clostridium difficile (C. difficile) infections.” 

Pandemic of superbugs
While terrorism is holding peace hostage around the world today, a more rampant but under the radar killer is on the loose and becoming more widespread, wiping out lives, as the medical community helplessly battles this pandemic situation of super bugs resistant to all drugs we currently have. Being at the mercy of these powerful and defiant microorganisms is a most scary situation. And they seem to be ahead of us.

Pneumonia and wound infections killed hundred of millions of people globally before penicillin was discovered in 1928 by Alexander Fleming, Professor of Bacteriology at St. Mary’s Hospital in London. Today, these conditions and hundreds of other infections respond well to penicillin and the other more sophisticated antibiotics, savings hundreds of millions of lives every century...until now, with the explosion of super bugs! 

Scary statistics
At least two million Americans develop drug resistant infections a year, and more than 23,000 of them die - 10 million deaths a year worldwide. This translates to $100 trillion sacrificed gross national products. Most of these scary infections occur in hospital settings, but they are also noted in the general community. These could be the commonly known conditions, like pneumonia or wound infection, but this time caused by drug-resistant bacteria, and hence, deadly. It is like retro-transporting us back to the early 1900s, the pre-penicillin era.

Lessons from the past
While two of the most devastating outbreaks of the Black Death (plague) that wiped out more than half of the population of Europe in the 14th Century killing about 75 million, leading to the final demise of the Roman Empire, was caused by two different strains of infectious agents from the black rats, one drug-resistant infection today could kill much more around the globe.

Just like us, humans, bacteria are active living microorganisms, with survival “instinct,” and when exposed to the drugs that aim to kill them, have the capacity to adapt by mutation and replication to become resistant to the drugs. When they become super bugs, they are untouchable killers, unless we develop new drugs effective against them.

Who to blame
We cannot blame the bacteria, which simply want to survive just like all living things. We, humans, healthcare providers and lay people, who abuse antibiotics, are to blame. Whether prescribed indiscriminately or purchased over the counter by self-medicating individuals, the widespread abuse of antibiotics make the bacteria mutate and grow resistance to them. 

Currently, there are at least six common pathogens that are drug-resistant, Klebsiella pneumoniae, E. Coli, and MRSA, and 3 global diseases: HIV, TB and malaria. There are many others. Unless science discovers fast ways to fight and kill these resistant superbugs with new drugs or methodology and we, the people, do not abuse their use, any and all of them will continue to kill humans and other animals with impunity around the world. 

Bacteria are on ALL surfaces
These microorganisms are on our skin, on our entire body. They are also all around us, in all surfaces, in our kitchen (which has more bacteria than our bathroom), all over our home, and in all public areas, like escalator hand rails, door knobs, cabinets, microwave oven door handle, countertops, tables, chairs, etc.. Paper money and coins are loaded with bacteria. If bacteria are on our skin and everywhere, why do we not always get infected? The reasons are factors like our skin integrity. If our skin is intact, the bacteria cannot invade us, except though our mucus linings (in our eyes, nose, mouth, ears, anus). This is where personal hygiene is essential. Touching our face contaminates it with bacteria. The other factor is the type and dose (number) of bacteria. Even if we have a skin abrasion or cut, if we thoroughly wash the affected area right away, the dose of bacteria will be so reduced our immune system can handle them to prevent infection. If the dose is not reduced, then we get skin infection. This is why all wounds must be washed clean immediately after sustaining them.

Simple hand-washing
On the prophylactic side, the simple habit of washing our hands religiously, at least 8 times a day (after going to the bathroom, before and after eating or working around the house or outside) can prevent contamination and infections, eliminating the need for antibiotics. This practice can also prevent viral infections, like common cold, for which some misinformed or uninformed individuals might opt to take antibiotics. Viral infections do NOT respond to antibiotics. This is just a waste of money, and worse, it will “encourage” bacteria in our body to develop antibiotic resistance. When treated longer than necessary, even bacterial infections commonly sensitive to specific antibiotics will increase the risk of the bacteria developing resistance. Skin sanitizers, preferably with skin moisturizer, in liquid, gel or foam, are helpful in minimizing infection. Those with sixty to 95 percent alcohol are most effective. Antibiotic Stewardship is also our individual responsibility as a member of society. Let’s all help prevent a super bug pandemic that could wipe us out of this wonderful world.

***

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