February 20, 2018, 5:56 am
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1 Philippine Peso = 0.07035 UAE Dirham
1 Philippine Peso = 2.03736 Albanian Lek
1 Philippine Peso = 0.0341 Neth Antilles Guilder
1 Philippine Peso = 0.37852 Argentine Peso
1 Philippine Peso = 0.02417 Australian Dollar
1 Philippine Peso = 0.0341 Aruba Florin
1 Philippine Peso = 0.03831 Barbados Dollar
1 Philippine Peso = 1.58755 Bangladesh Taka
1 Philippine Peso = 0.03006 Bulgarian Lev
1 Philippine Peso = 0.00722 Bahraini Dinar
1 Philippine Peso = 33.54368 Burundi Franc
1 Philippine Peso = 0.01916 Bermuda Dollar
1 Philippine Peso = 0.02532 Brunei Dollar
1 Philippine Peso = 0.13142 Bolivian Boliviano
1 Philippine Peso = 0.06189 Brazilian Real
1 Philippine Peso = 0.01916 Bahamian Dollar
1 Philippine Peso = 1.22893 Bhutan Ngultrum
1 Philippine Peso = 0.18046 Botswana Pula
1 Philippine Peso = 383.5249 Belarus Ruble
1 Philippine Peso = 0.03827 Belize Dollar
1 Philippine Peso = 0.02404 Canadian Dollar
1 Philippine Peso = 0.01774 Swiss Franc
1 Philippine Peso = 11.3659 Chilean Peso
1 Philippine Peso = 0.12153 Chinese Yuan
1 Philippine Peso = 54.27203 Colombian Peso
1 Philippine Peso = 10.83966 Costa Rica Colon
1 Philippine Peso = 0.01916 Cuban Peso
1 Philippine Peso = 1.70268 Cape Verde Escudo
1 Philippine Peso = 0.39128 Czech Koruna
1 Philippine Peso = 3.38755 Djibouti Franc
1 Philippine Peso = 0.115 Danish Krone
1 Philippine Peso = 0.93544 Dominican Peso
1 Philippine Peso = 2.16856 Algerian Dinar
1 Philippine Peso = 0.24138 Estonian Kroon
1 Philippine Peso = 0.33716 Egyptian Pound
1 Philippine Peso = 0.52165 Ethiopian Birr
1 Philippine Peso = 0.01543 Euro
1 Philippine Peso = 0.03813 Fiji Dollar
1 Philippine Peso = 0.01366 Falkland Islands Pound
1 Philippine Peso = 0.01366 British Pound
1 Philippine Peso = 0.08656 Ghanaian Cedi
1 Philippine Peso = 0.89866 Gambian Dalasi
1 Philippine Peso = 172.37548 Guinea Franc
1 Philippine Peso = 0.14054 Guatemala Quetzal
1 Philippine Peso = 3.9364 Guyana Dollar
1 Philippine Peso = 0.14982 Hong Kong Dollar
1 Philippine Peso = 0.45019 Honduras Lempira
1 Philippine Peso = 0.11447 Croatian Kuna
1 Philippine Peso = 1.21437 Haiti Gourde
1 Philippine Peso = 4.80326 Hungarian Forint
1 Philippine Peso = 259.67432 Indonesian Rupiah
1 Philippine Peso = 0.06787 Israeli Shekel
1 Philippine Peso = 1.23063 Indian Rupee
1 Philippine Peso = 22.68199 Iraqi Dinar
1 Philippine Peso = 709.84673 Iran Rial
1 Philippine Peso = 1.91667 Iceland Krona
1 Philippine Peso = 2.39444 Jamaican Dollar
1 Philippine Peso = 0.01355 Jordanian Dinar
1 Philippine Peso = 2.03307 Japanese Yen
1 Philippine Peso = 1.93774 Kenyan Shilling
1 Philippine Peso = 1.30544 Kyrgyzstan Som
1 Philippine Peso = 76.53257 Cambodia Riel
1 Philippine Peso = 7.57567 Comoros Franc
1 Philippine Peso = 17.24138 North Korean Won
1 Philippine Peso = 20.41552 Korean Won
1 Philippine Peso = 0.00573 Kuwaiti Dinar
1 Philippine Peso = 0.01571 Cayman Islands Dollar
1 Philippine Peso = 6.12088 Kazakhstan Tenge
1 Philippine Peso = 158.62069 Lao Kip
1 Philippine Peso = 28.83908 Lebanese Pound
1 Philippine Peso = 2.97165 Sri Lanka Rupee
1 Philippine Peso = 2.44272 Liberian Dollar
1 Philippine Peso = 0.22308 Lesotho Loti
1 Philippine Peso = 0.0584 Lithuanian Lita
1 Philippine Peso = 0.01189 Latvian Lat
1 Philippine Peso = 0.02534 Libyan Dinar
1 Philippine Peso = 0.17539 Moroccan Dirham
1 Philippine Peso = 0.31734 Moldovan Leu
1 Philippine Peso = 0.9454 Macedonian Denar
1 Philippine Peso = 25.42146 Myanmar Kyat
1 Philippine Peso = 45.82375 Mongolian Tugrik
1 Philippine Peso = 0.15425 Macau Pataca
1 Philippine Peso = 6.68582 Mauritania Ougulya
1 Philippine Peso = 0.61303 Mauritius Rupee
1 Philippine Peso = 0.29828 Maldives Rufiyaa
1 Philippine Peso = 13.66743 Malawi Kwacha
1 Philippine Peso = 0.35467 Mexican Peso
1 Philippine Peso = 0.07454 Malaysian Ringgit
1 Philippine Peso = 0.22274 Namibian Dollar
1 Philippine Peso = 6.87739 Nigerian Naira
1 Philippine Peso = 0.59195 Nicaragua Cordoba
1 Philippine Peso = 0.14901 Norwegian Krone
1 Philippine Peso = 1.96697 Nepalese Rupee
1 Philippine Peso = 0.02593 New Zealand Dollar
1 Philippine Peso = 0.00737 Omani Rial
1 Philippine Peso = 0.01916 Panama Balboa
1 Philippine Peso = 0.06225 Peruvian Nuevo Sol
1 Philippine Peso = 0.06025 Papua New Guinea Kina
1 Philippine Peso = 1 Philippine Peso
1 Philippine Peso = 2.11398 Pakistani Rupee
1 Philippine Peso = 0.0642 Polish Zloty
1 Philippine Peso = 106.68774 Paraguayan Guarani
1 Philippine Peso = 0.06973 Qatar Rial
1 Philippine Peso = 0.07198 Romanian New Leu
1 Philippine Peso = 1.08044 Russian Rouble
1 Philippine Peso = 16.10153 Rwanda Franc
1 Philippine Peso = 0.07184 Saudi Arabian Riyal
1 Philippine Peso = 0.14875 Solomon Islands Dollar
1 Philippine Peso = 0.25546 Seychelles Rupee
1 Philippine Peso = 0.34393 Sudanese Pound
1 Philippine Peso = 0.15255 Swedish Krona
1 Philippine Peso = 0.02511 Singapore Dollar
1 Philippine Peso = 0.01367 St Helena Pound
1 Philippine Peso = 0.4254 Slovak Koruna
1 Philippine Peso = 146.16858 Sierra Leone Leone
1 Philippine Peso = 10.76628 Somali Shilling
1 Philippine Peso = 378.35439 Sao Tome Dobra
1 Philippine Peso = 0.16762 El Salvador Colon
1 Philippine Peso = 9.86552 Syrian Pound
1 Philippine Peso = 0.22276 Swaziland Lilageni
1 Philippine Peso = 0.59923 Thai Baht
1 Philippine Peso = 0.04546 Tunisian Dinar
1 Philippine Peso = 0.04238 Tongan paʻanga
1 Philippine Peso = 0.07167 Turkish Lira
1 Philippine Peso = 0.12904 Trinidad Tobago Dollar
1 Philippine Peso = 0.55669 Taiwan Dollar
1 Philippine Peso = 43.02682 Tanzanian Shilling
1 Philippine Peso = 0.51715 Ukraine Hryvnia
1 Philippine Peso = 69.38697 Ugandan Shilling
1 Philippine Peso = 0.01916 United States Dollar
1 Philippine Peso = 0.54521 Uruguayan New Peso
1 Philippine Peso = 156.47509 Uzbekistan Sum
1 Philippine Peso = 477.73945 Venezuelan Bolivar
1 Philippine Peso = 434.75095 Vietnam Dong
1 Philippine Peso = 2.01916 Vanuatu Vatu
1 Philippine Peso = 0.04802 Samoa Tala
1 Philippine Peso = 10.11303 CFA Franc (BEAC)
1 Philippine Peso = 0.05172 East Caribbean Dollar
1 Philippine Peso = 10.11303 CFA Franc (BCEAO)
1 Philippine Peso = 1.81628 Pacific Franc
1 Philippine Peso = 4.78831 Yemen Riyal
1 Philippine Peso = 0.22279 South African Rand
1 Philippine Peso = 99.41571 Zambian Kwacha
1 Philippine Peso = 6.93295 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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