June 21, 2018, 2:03 am
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1 Philippine Peso = 0.06897 UAE Dirham
1 Philippine Peso = 2.04526 Albanian Lek
1 Philippine Peso = 0.03404 Neth Antilles Guilder
1 Philippine Peso = 0.52113 Argentine Peso
1 Philippine Peso = 0.02544 Australian Dollar
1 Philippine Peso = 0.03343 Aruba Florin
1 Philippine Peso = 0.03756 Barbados Dollar
1 Philippine Peso = 1.57728 Bangladesh Taka
1 Philippine Peso = 0.03184 Bulgarian Lev
1 Philippine Peso = 0.00709 Bahraini Dinar
1 Philippine Peso = 32.88225 Burundi Franc
1 Philippine Peso = 0.01878 Bermuda Dollar
1 Philippine Peso = 0.02522 Brunei Dollar
1 Philippine Peso = 0.12883 Bolivian Boliviano
1 Philippine Peso = 0.07009 Brazilian Real
1 Philippine Peso = 0.01878 Bahamian Dollar
1 Philippine Peso = 1.277 Bhutan Ngultrum
1 Philippine Peso = 0.19573 Botswana Pula
1 Philippine Peso = 375.96244 Belarus Ruble
1 Philippine Peso = 0.03752 Belize Dollar
1 Philippine Peso = 0.02494 Canadian Dollar
1 Philippine Peso = 0.01868 Swiss Franc
1 Philippine Peso = 12.01146 Chilean Peso
1 Philippine Peso = 0.12169 Chinese Yuan
1 Philippine Peso = 54.86948 Colombian Peso
1 Philippine Peso = 10.59718 Costa Rica Colon
1 Philippine Peso = 0.01878 Cuban Peso
1 Philippine Peso = 1.78854 Cape Verde Escudo
1 Philippine Peso = 0.41869 Czech Koruna
1 Philippine Peso = 3.33333 Djibouti Franc
1 Philippine Peso = 0.12088 Danish Krone
1 Philippine Peso = 0.93052 Dominican Peso
1 Philippine Peso = 2.20053 Algerian Dinar
1 Philippine Peso = 0.25367 Estonian Kroon
1 Philippine Peso = 0.33502 Egyptian Pound
1 Philippine Peso = 0.51117 Ethiopian Birr
1 Philippine Peso = 0.01621 Euro
1 Philippine Peso = 0.03897 Fiji Dollar
1 Philippine Peso = 0.01426 Falkland Islands Pound
1 Philippine Peso = 0.01425 British Pound
1 Philippine Peso = 0.08833 Ghanaian Cedi
1 Philippine Peso = 0.87962 Gambian Dalasi
1 Philippine Peso = 169.05164 Guinea Franc
1 Philippine Peso = 0.14052 Guatemala Quetzal
1 Philippine Peso = 3.88526 Guyana Dollar
1 Philippine Peso = 0.14739 Hong Kong Dollar
1 Philippine Peso = 0.44866 Honduras Lempira
1 Philippine Peso = 0.1197 Croatian Kuna
1 Philippine Peso = 1.23812 Haiti Gourde
1 Philippine Peso = 5.22103 Hungarian Forint
1 Philippine Peso = 261.46479 Indonesian Rupiah
1 Philippine Peso = 0.06819 Israeli Shekel
1 Philippine Peso = 1.27817 Indian Rupee
1 Philippine Peso = 22.23474 Iraqi Dinar
1 Philippine Peso = 796.99531 Iran Rial
1 Philippine Peso = 2.05333 Iceland Krona
1 Philippine Peso = 2.4507 Jamaican Dollar
1 Philippine Peso = 0.01331 Jordanian Dinar
1 Philippine Peso = 2.06607 Japanese Yen
1 Philippine Peso = 1.89577 Kenyan Shilling
1 Philippine Peso = 1.28255 Kyrgyzstan Som
1 Philippine Peso = 75.84601 Cambodia Riel
1 Philippine Peso = 7.92488 Comoros Franc
1 Philippine Peso = 16.90141 North Korean Won
1 Philippine Peso = 20.8492 Korean Won
1 Philippine Peso = 0.00568 Kuwaiti Dinar
1 Philippine Peso = 0.0154 Cayman Islands Dollar
1 Philippine Peso = 6.40488 Kazakhstan Tenge
1 Philippine Peso = 157.33333 Lao Kip
1 Philippine Peso = 28.26291 Lebanese Pound
1 Philippine Peso = 3.00282 Sri Lanka Rupee
1 Philippine Peso = 2.66254 Liberian Dollar
1 Philippine Peso = 0.2584 Lesotho Loti
1 Philippine Peso = 0.05725 Lithuanian Lita
1 Philippine Peso = 0.01165 Latvian Lat
1 Philippine Peso = 0.02546 Libyan Dinar
1 Philippine Peso = 0.17921 Moroccan Dirham
1 Philippine Peso = 0.31576 Moldovan Leu
1 Philippine Peso = 0.99324 Macedonian Denar
1 Philippine Peso = 25.69014 Myanmar Kyat
1 Philippine Peso = 45.33333 Mongolian Tugrik
1 Philippine Peso = 0.15181 Macau Pataca
1 Philippine Peso = 6.66667 Mauritania Ougulya
1 Philippine Peso = 0.65765 Mauritius Rupee
1 Philippine Peso = 0.29239 Maldives Rufiyaa
1 Philippine Peso = 13.39812 Malawi Kwacha
1 Philippine Peso = 0.3853 Mexican Peso
1 Philippine Peso = 0.07515 Malaysian Ringgit
1 Philippine Peso = 0.25797 Namibian Dollar
1 Philippine Peso = 6.74178 Nigerian Naira
1 Philippine Peso = 0.59151 Nicaragua Cordoba
1 Philippine Peso = 0.15379 Norwegian Krone
1 Philippine Peso = 2.0385 Nepalese Rupee
1 Philippine Peso = 0.0272 New Zealand Dollar
1 Philippine Peso = 0.00723 Omani Rial
1 Philippine Peso = 0.01878 Panama Balboa
1 Philippine Peso = 0.06164 Peruvian Nuevo Sol
1 Philippine Peso = 0.06142 Papua New Guinea Kina
1 Philippine Peso = 1 Philippine Peso
1 Philippine Peso = 2.28545 Pakistani Rupee
1 Philippine Peso = 0.06993 Polish Zloty
1 Philippine Peso = 106.70047 Paraguayan Guarani
1 Philippine Peso = 0.06835 Qatar Rial
1 Philippine Peso = 0.07565 Romanian New Leu
1 Philippine Peso = 1.1966 Russian Rouble
1 Philippine Peso = 15.95174 Rwanda Franc
1 Philippine Peso = 0.07042 Saudi Arabian Riyal
1 Philippine Peso = 0.14841 Solomon Islands Dollar
1 Philippine Peso = 0.25277 Seychelles Rupee
1 Philippine Peso = 0.33719 Sudanese Pound
1 Philippine Peso = 0.16718 Swedish Krona
1 Philippine Peso = 0.02548 Singapore Dollar
1 Philippine Peso = 0.01426 St Helena Pound
1 Philippine Peso = 0.41701 Slovak Koruna
1 Philippine Peso = 149.29577 Sierra Leone Leone
1 Philippine Peso = 10.57277 Somali Shilling
1 Philippine Peso = 397.4216 Sao Tome Dobra
1 Philippine Peso = 0.16432 El Salvador Colon
1 Philippine Peso = 9.67099 Syrian Pound
1 Philippine Peso = 0.25817 Swaziland Lilageni
1 Philippine Peso = 0.61446 Thai Baht
1 Philippine Peso = 0.04845 Tunisian Dinar
1 Philippine Peso = 0.04326 Tongan paʻanga
1 Philippine Peso = 0.08905 Turkish Lira
1 Philippine Peso = 0.12487 Trinidad Tobago Dollar
1 Philippine Peso = 0.56648 Taiwan Dollar
1 Philippine Peso = 42.59155 Tanzanian Shilling
1 Philippine Peso = 0.49596 Ukraine Hryvnia
1 Philippine Peso = 72.33803 Ugandan Shilling
1 Philippine Peso = 0.01878 United States Dollar
1 Philippine Peso = 0.59211 Uruguayan New Peso
1 Philippine Peso = 147.69953 Uzbekistan Sum
1 Philippine Peso = 1498.59155 Venezuelan Bolivar
1 Philippine Peso = 429.12676 Vietnam Dong
1 Philippine Peso = 2.02911 Vanuatu Vatu
1 Philippine Peso = 0.04869 Samoa Tala
1 Philippine Peso = 10.62592 CFA Franc (BEAC)
1 Philippine Peso = 0.0507 East Caribbean Dollar
1 Philippine Peso = 10.62592 CFA Franc (BCEAO)
1 Philippine Peso = 1.92432 Pacific Franc
1 Philippine Peso = 4.69202 Yemen Riyal
1 Philippine Peso = 0.25823 South African Rand
1 Philippine Peso = 97.4554 Zambian Kwacha
1 Philippine Peso = 6.79624 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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