November 22, 2017, 1:26 pm
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1 Philippine Peso = 0.07222 UAE Dirham
1 Philippine Peso = 2.23697 Albanian Lek
1 Philippine Peso = 0.035 Neth Antilles Guilder
1 Philippine Peso = 0.34334 Argentine Peso
1 Philippine Peso = 0.02609 Australian Dollar
1 Philippine Peso = 0.035 Aruba Florin
1 Philippine Peso = 0.03933 Barbados Dollar
1 Philippine Peso = 1.63992 Bangladesh Taka
1 Philippine Peso = 0.03265 Bulgarian Lev
1 Philippine Peso = 0.00741 Bahraini Dinar
1 Philippine Peso = 34.27689 Burundi Franc
1 Philippine Peso = 0.01967 Bermuda Dollar
1 Philippine Peso = 0.02668 Brunei Dollar
1 Philippine Peso = 0.13491 Bolivian Boliviano
1 Philippine Peso = 0.06405 Brazilian Real
1 Philippine Peso = 0.01967 Bahamian Dollar
1 Philippine Peso = 1.28171 Bhutan Ngultrum
1 Philippine Peso = 0.20626 Botswana Pula
1 Philippine Peso = 393.707 Belarus Ruble
1 Philippine Peso = 0.03929 Belize Dollar
1 Philippine Peso = 0.0252 Canadian Dollar
1 Philippine Peso = 0.01953 Swiss Franc
1 Philippine Peso = 12.51721 Chilean Peso
1 Philippine Peso = 0.13055 Chinese Yuan
1 Philippine Peso = 59.27237 Colombian Peso
1 Philippine Peso = 11.06096 Costa Rica Colon
1 Philippine Peso = 0.01967 Cuban Peso
1 Philippine Peso = 1.84798 Cape Verde Escudo
1 Philippine Peso = 0.42782 Czech Koruna
1 Philippine Peso = 3.47748 Djibouti Franc
1 Philippine Peso = 0.12472 Danish Krone
1 Philippine Peso = 0.93215 Dominican Peso
1 Philippine Peso = 2.25679 Algerian Dinar
1 Philippine Peso = 0.26216 Estonian Kroon
1 Philippine Peso = 0.34612 Egyptian Pound
1 Philippine Peso = 0.53196 Ethiopian Birr
1 Philippine Peso = 0.01676 Euro
1 Philippine Peso = 0.0411 Fiji Dollar
1 Philippine Peso = 0.01485 Falkland Islands Pound
1 Philippine Peso = 0.01485 British Pound
1 Philippine Peso = 0.09043 Ghanaian Cedi
1 Philippine Peso = 0.92566 Gambian Dalasi
1 Philippine Peso = 176.89283 Guinea Franc
1 Philippine Peso = 0.14439 Guatemala Quetzal
1 Philippine Peso = 4.01731 Guyana Dollar
1 Philippine Peso = 0.15359 Hong Kong Dollar
1 Philippine Peso = 0.46264 Honduras Lempira
1 Philippine Peso = 0.12608 Croatian Kuna
1 Philippine Peso = 1.21691 Haiti Gourde
1 Philippine Peso = 5.23442 Hungarian Forint
1 Philippine Peso = 266.33236 Indonesian Rupiah
1 Philippine Peso = 0.06904 Israeli Shekel
1 Philippine Peso = 1.28012 Indian Rupee
1 Philippine Peso = 22.94985 Iraqi Dinar
1 Philippine Peso = 692.86138 Iran Rial
1 Philippine Peso = 2.03638 Iceland Krona
1 Philippine Peso = 2.46903 Jamaican Dollar
1 Philippine Peso = 0.01391 Jordanian Dinar
1 Philippine Peso = 2.2151 Japanese Yen
1 Philippine Peso = 2.03441 Kenyan Shilling
1 Philippine Peso = 1.37082 Kyrgyzstan Som
1 Philippine Peso = 78.99705 Cambodia Riel
1 Philippine Peso = 8.32547 Comoros Franc
1 Philippine Peso = 17.69912 North Korean Won
1 Philippine Peso = 21.59685 Korean Won
1 Philippine Peso = 0.00593 Kuwaiti Dinar
1 Philippine Peso = 0.01613 Cayman Islands Dollar
1 Philippine Peso = 6.50443 Kazakhstan Tenge
1 Philippine Peso = 163.16618 Lao Kip
1 Philippine Peso = 29.60669 Lebanese Pound
1 Philippine Peso = 3.02262 Sri Lanka Rupee
1 Philippine Peso = 2.44897 Liberian Dollar
1 Philippine Peso = 0.2763 Lesotho Loti
1 Philippine Peso = 0.05995 Lithuanian Lita
1 Philippine Peso = 0.0122 Latvian Lat
1 Philippine Peso = 0.02689 Libyan Dinar
1 Philippine Peso = 0.18578 Moroccan Dirham
1 Philippine Peso = 0.34307 Moldovan Leu
1 Philippine Peso = 1.02635 Macedonian Denar
1 Philippine Peso = 26.80433 Myanmar Kyat
1 Philippine Peso = 47.94494 Mongolian Tugrik
1 Philippine Peso = 0.15822 Macau Pataca
1 Philippine Peso = 6.90266 Mauritania Ougulya
1 Philippine Peso = 0.6647 Mauritius Rupee
1 Philippine Peso = 0.30619 Maldives Rufiyaa
1 Philippine Peso = 14.0885 Malawi Kwacha
1 Philippine Peso = 0.37348 Mexican Peso
1 Philippine Peso = 0.08155 Malaysian Ringgit
1 Philippine Peso = 0.27622 Namibian Dollar
1 Philippine Peso = 7.00098 Nigerian Naira
1 Philippine Peso = 0.60177 Nicaragua Cordoba
1 Philippine Peso = 0.16317 Norwegian Krone
1 Philippine Peso = 2.03638 Nepalese Rupee
1 Philippine Peso = 0.02891 New Zealand Dollar
1 Philippine Peso = 0.00756 Omani Rial
1 Philippine Peso = 0.01967 Panama Balboa
1 Philippine Peso = 0.06359 Peruvian Nuevo Sol
1 Philippine Peso = 0.06374 Papua New Guinea Kina
1 Philippine Peso = 1 Philippine Peso
1 Philippine Peso = 2.06568 Pakistani Rupee
1 Philippine Peso = 0.07087 Polish Zloty
1 Philippine Peso = 110.87513 Paraguayan Guarani
1 Philippine Peso = 0.07473 Qatar Rial
1 Philippine Peso = 0.07785 Romanian New Leu
1 Philippine Peso = 1.16841 Russian Rouble
1 Philippine Peso = 16.36755 Rwanda Franc
1 Philippine Peso = 0.07374 Saudi Arabian Riyal
1 Philippine Peso = 0.15449 Solomon Islands Dollar
1 Philippine Peso = 0.26735 Seychelles Rupee
1 Philippine Peso = 0.13097 Sudanese Pound
1 Philippine Peso = 0.16686 Swedish Krona
1 Philippine Peso = 0.0267 Singapore Dollar
1 Philippine Peso = 0.01486 St Helena Pound
1 Philippine Peso = 0.4367 Slovak Koruna
1 Philippine Peso = 149.85251 Sierra Leone Leone
1 Philippine Peso = 10.99312 Somali Shilling
1 Philippine Peso = 410.64307 Sao Tome Dobra
1 Philippine Peso = 0.17207 El Salvador Colon
1 Philippine Peso = 10.12743 Syrian Pound
1 Philippine Peso = 0.27624 Swaziland Lilageni
1 Philippine Peso = 0.64562 Thai Baht
1 Philippine Peso = 0.04905 Tunisian Dinar
1 Philippine Peso = 0.04547 Tongan paʻanga
1 Philippine Peso = 0.07723 Turkish Lira
1 Philippine Peso = 0.13037 Trinidad Tobago Dollar
1 Philippine Peso = 0.59133 Taiwan Dollar
1 Philippine Peso = 43.93314 Tanzanian Shilling
1 Philippine Peso = 0.51976 Ukraine Hryvnia
1 Philippine Peso = 71.28811 Ugandan Shilling
1 Philippine Peso = 0.01967 United States Dollar
1 Philippine Peso = 0.57699 Uruguayan New Peso
1 Philippine Peso = 158.89873 Uzbekistan Sum
1 Philippine Peso = 0.19617 Venezuelan Bolivar
1 Philippine Peso = 446.39136 Vietnam Dong
1 Philippine Peso = 2.10089 Vanuatu Vatu
1 Philippine Peso = 0.05108 Samoa Tala
1 Philippine Peso = 10.98368 CFA Franc (BEAC)
1 Philippine Peso = 0.0531 East Caribbean Dollar
1 Philippine Peso = 10.988 CFA Franc (BCEAO)
1 Philippine Peso = 1.98682 Pacific Franc
1 Philippine Peso = 4.91504 Yemen Riyal
1 Philippine Peso = 0.2763 South African Rand
1 Philippine Peso = 102.05507 Zambian Kwacha
1 Philippine Peso = 7.11701 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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