Minggu, 31 Januari 2016

Credit ECDC

Epidemiological update

- See more at: http://ecdc.europa.eu/en/press/news/_layouts/forms/News_DispForm.aspx?ID=1350&List=8db7286c-fe2d-476c-9133-18ff4cb1b568&Source=http%3A%2F%2Fecdc%2Eeuropa%2Eeu%2Fen%2FPages%2Fhome%2Easpx#sthash.GNv94r0o.dpufE

Epidemiological update

- See more at: http://ecdc.europa.eu/en/press/news/_layouts/forms/News_DispForm.aspx?ID=1350&List=8db7286c-fe2d-476c-9133-18ff4cb1b568&Source=http%3A%2F%2Fecdc%2Eeuropa%2Eeu%2Fen%2FPages%2Fhome%2Easpx#sthash.GNv94r0o.dpuf















#10,949


The parallels between the evolution and progression of Zika and Chikungunya are nothing less than striking. 


Until the middle of the last decade both were relatively obscure, neglected tropical diseases, which were limited to sparking small low-impact outbreaks in east and central Africa. Both produced (generally mild) dengue-like symptoms, and both launched themselves on their respective world tours around the same time via the Indian Ocean/Pacific island route.

Chikungunya was the first out of the gate, making a surprise leap to the Indian Ocean island of Réunion in 2005. There, it infected nearly 1/3rd of the island’s 770,000 residents (see 2006 EID article Chikungunya Disease Outbreak, Reunion Island) in just a matter of months.


From there it quickly cut a swath across the Indian ocean, into southeast Asia, and into the Pacific.


It arrived on the  French Part of St. Martins in the fall of 2013, likely carried in by an infected tourist, and quickly spread across the Caribbean and into South and Central America. In the two years since it arrived in the Americas, it has likely infected more than 2 million people.


Zika appears to have arrived in Brazil in 2014, probably carried in by a viremic visitor from the South Pacific, where the virus had slowly been spreading since 2007 (see 2009 EID Journal Zika Virus Outside Africa by Edward B. Hayes).


As its symptoms are generally milder than both CHKV and Dengue, it wasn't until the summer of 2015 that Brazil recognized it was in the midst of a Zika epidemic.

But by October it was reported in Columbia, and over the next four months, it appeared in more than 2 dozen countries and territories across the Caribbean, South and Central America. It is likely already present in many other regions, but has yet to be picked up by surveillance. 

It has only been since November that suspicions have been raised that Zika infection might not be quite as benign as previously believed (see WHO To Convene IHR Emergency Committee Meeting On Zika).


This rapid spread, and possible shift in virulence, has led to speculation that the Zika virus has changed somehow from its milder African version; transmitting more efficiently via mosquitoes or perhaps replicating more efficiently in human hosts.  


Nearly two months ago, in Paper: Zika Adaptations To Humans Helped Spark Global Spread, we looked at a study - yet to be peer reviewed - by researchers at the University of Sao Paulo and the Pasteur Institute of Dakar (Senegal) who believe they have uncovered genetic changes in the Zika virus that occurred after the virus reached the South Pacific in 2007, that may make it better adapted to human physiology.


While we've yet to see any definitive proof that such a change has occurred, in the past few days the subject has come up repeatedly in the media.

A few days ago the Harvard University School of Public Health ran an article called Zika virus in Brazil may be mutated strain while the New Scientist recently carried a report called Did Zika’s recent mutations let it explode as a global threat?


Today, a report from the Anadolu Agency also touches on this idea, with an interview with a Ugandan researcher who believes the virus has adapted to humans during its trek across the Pacifc.

Uganda virus expert says Zika adapting to humans


A top scientist at the Uganda-based facility that first identified the Zika virus has told Anadolu Agency that the bug is multiplying and becoming more adaptable to humans.

Dr. Julius Lutwama, senior principal research officer at the Uganda Virus Research Institute, said the virus outbreak in the Americas can only be reduced by supportive treatment and through controlling disease-carrying mosquitoes.

“There are two strains of the Zika virus, which include the African Zika virus and the Asian strain, which are slightly different,” he said.

“The strain that is causing problems in the Americas comes from Asia, went to Micronesia, Polynesia and moved to South America.” 

Again, all of this is far from settled science, but it is worth noting that CHKV appears to have benefited from a mutation in the middle of the last decade that allowed it to spread more  efficiently by the Aedes Albopictus mosquito (see A Single Mutation in Chikungunya Virus Affects Vector Specificity and Epidemic Potential).

We have, quite frankly, very little research in the literature on Zika - at least when you compare it to what's available for Dengue, Chikungunya, or West Nile Virus.  That will change over time, now that Zika is viewed as potentially more dangerous than previously believed, but good research takes time. 

Below you'll find an early example, via the CDC's EID Journal. A letter reviewing the expansion of Zika out of Africa (and its similarities to CHKV), along with phylogenic analysis of early samples collected in the Americas.

It doesn't answer the question as to whether the virus has recently `adapted' to humans or mosquitoes, but it does find the Zika virus has evolved into 3 distinct genotypes (East Africa, West Africa, and Asia) and that the Asian genotype is the one that has arrived in the Americas.

Follow the link to read:


Volume 22, Number 5—May 2016


Letter


Phylogeny of Zika Virus in Western Hemisphere, 2015


To the Editor: Zika virus (ZIKV) belongs to the genus Flavivirus, family Flaviviridae, and is transmitted by Aedes spp. mosquitoes. Clinical signs and symptoms of human infection with ZIKV include fever, headache, malaise, maculopapular rash, and conjunctivitis.
ZIKV was first isolated in 1947 from the blood of a febrile sentinel rhesus monkey during a study of yellow fever in the Zika Forest of Uganda (1). During the next 20 years, ZIKV isolates were obtained primarily from East and West Africa during arbovirus surveillance studies in the absence of epidemics. During those 20 years, cases of ZIKV infection were detected sporadically; however, given the clinical similarity of ZIKV and dengue virus infections and the extensive cross-reactivity of ZIKV antibodies with dengue viruses, it is possible that ZIKV was associated with epidemics that were incorrectly attributed to dengue viruses. Beginning in 2007, substantial ZIKV outbreaks were reported first in Yap Island (Federated States of Micronesia), then in French Polynesia, and then in other Pacific Islands (24).

Genetic studies have revealed that ZIKV has evolved into 3 distinct genotypes: West African (Nigerian cluster), East African (MR766 prototype cluster), and Asian. It has been postulated that the virus originated in East Africa and then spread into both West Africa and Asia ≈50–100 years ago (5). In early 2015, cases of ZIKV infection were detected in Rio Grande State, northern Brazil, and limited sequence analyses revealed that the virus was most closely related to a 2013 ZIKV from French Polynesia, within the Asian clade (6).

(SNIP)

As reported by Musso et al. (8), the phylogeny and movement of ZIKV and chikungunya virus are strikingly similar. Each virus is grouped into 3 genotypes of very similar geographic distribution: East Africa, West Africa, and Asia. For both viruses, it also seems that viruses from East Africa moved into Asia ≈50–100 years ago and evolved into a unique Asian genotype (9,10). In addition, the similarity with respect to the recent movement of these viruses from Asia into the Pacific Islands and then into the New World (9) is noteworthy. It seems that similar ecologic and/or human social factors might be responsible for the movement of chikungunya virus and ZIKV into the New World at approximately the same time. 

Further studies might elucidate the exact mechanism of this transcontinental movement, leading to effective prevention strategies.
PAHO - Zika Spread Epi Week 4



















#10,948


It is practically an axiom of infectious disease blogging that the first details you get on any emerging disease outbreak are nearly always wrong, or at least misleading. Rarely are all of the pieces to the puzzle immediately available, and the media's narrative is often geared more to boosting circulation than presenting the facts.

As a result, I only sparingly use media accounts in this blog and try to use official releases of information where I can.   Of course, those are often wrong (or biased), as well.

I've called it the `fog of flu'  before - borne of situations where there are alarming but ambiguous reports of something `bad' breaking out - but very little real information.  We deal with it every winter, as we try to parse out the avian H5N1, H5N6 and H7N9 cases from the yearly cascade of seasonal flu and other respiratory outbreaks in places like Egypt and China.


Since November we've been aware of reports of elevated cases of microcephaly in Brazil which the local authorities have tentatively linked to the arrival of Zika last spring. The case numbers have been alarming, the stories of its impact tragic, and we've seen strong warnings issued by our own CDC regarding travel to the region by pregnant women.

But despite all of that, it is far from clear what is going on with Brazil's rates of microcephaly, or even if Zika is responsible.

Overnight both Crof and Dr. Ian Mackay have weighed in on this topic, and I encourage you to read both of their efforts.

First Crof, whose excellent analysis of the (admittedly sketchy) numbers to date (see Is microcephaly surging in Brazil, or just  efforts to find it?), was inspired by Declan Butler's Nature News & Comment article Report questions size of surge in Brazil's microcephaly cases.

Ian took a hard look at this week's  MMWR report Possible Association Between Zika Virus Infection and Microcephaly — Brazil, 2015, and finds it wanting in:

Microcephaly in Brazil: is it occurring in greater numbers than normal or not?

A paper came out yesterday (AEST) from Morbidity and Mortality Weekly Report (MMWR) with the heading...



Possible Association Between Zika Virus Infection and Microcephaly — Brazil, 2015

Reads as though some great data may finally show us a hint of an association between Zika virus (ZIKV) infection and microcephaly disease. Right? 

Nope. There are none. At least none that could approach satisfying that title which highlights that it is not just the popular media who can generate misleading titles (headlines in their case).
(Continue. . .)


This lack of evidence doesn't mean the evidence won't be found, or that a problem doesn't exist.  Only that there are an awful lot of questions yet to be answered.

CIDRAP Director Dr. Michael Osterholm, on the other hand, already finds the evidence compelling. He looks at the rise in mosquito-borne threats in the Americas - due in large part to the cutbacks in mosquito control efforts over the past couple of decades - in:

How Scared Should You Be About Zika?


Zika, or perhaps co-infection (or sequential infection) with Zika and other similar arboviruses (DENV, CHKV), may very well turn out to be responsible for increased rates of microcephaly, spikes in Guillain-Barré syndrome (GBS), or other serious outcomes.

Other viral infections have produced similar impacts, so it is certainly plausible.  But until we know for sure, it is important not ignore other possibilities.

While it may be overstated, I find it hard to believe Brazil's reported surge in microcephaly is due entirely to observational bias, even granting that the base line numbers are suspect and most of the cases are still only suspected.  Something certainly seems amiss.

But that's what epidemiological investigations are for . . . to find out

There are other issues, other unknowns, including determining exactly what species of mosquitoes can (and cannot) transmit the virus, that will need to be nailed down by scientists before we can accurately gauge the impact Zika will have on North America.

I certainly have no inside information or special insight into all of this - but considering the potential impacts to individuals, to families, and to society - it seems only prudent to regard Zika as the most likely culprit - at least until proven otherwise.

Which means, until we know different, the smart money will be on preparing to deal with an enhanced mosquito threat this summer, and likely for many years to come.


Because if it isn't Zika, there's always WNV, Dengue, CHKV, and EEE out there, and they can all ruin your entire day.

Jumat, 29 Januari 2016

CREDIT CDC Avian Flu












#10,947



With so many new and emerging avian flu viruses popping up in poultry and wild birds, both in the United States and around the world, I suppose it was only a matter of time before a new term would appear describing them:

 Avian Influenza Viruses Of Public Health Concern.

The list, which started off with H5N1, and a couple of H7 viruses, has grown rapidly over the past several years, and now includes H5N1, H7N9, H10N8, H5N6, H7N8, H5N2, H5N8, H5N9, H7N7, H7N2, H7N3, H9N2 . . . among others.


Only a handful of these avian viruses are known to infect humans, and of those, all but a few (H5N1, H5N5, H7N9, H10N8) usually produce mild, self-limiting influenza-like symptoms.  

Unless you work with live poultry, purchase birds from a live market, or are involved in the culling of infected birds, your odds of exposure right now are pretty slim. But, in the words of the CDC:

Avian influenza virus infections in humans are of public health concern, not only because of the illness they may cause, but because of their pandemic potential.
Some avian influenza viruses have been associated with greater numbers of human infections and more serious illnesses in people and therefore may pose a greater known public health risk. Avian influenza viruses of particular public health concern include (1) those viruses which are known to have caused severe disease in humans, such as highly-pathogenic avian influenza (HPAI) A (H5N1) virus and low-pathogenic avian influenza (LPAI) A (H7N9) virus.
Also, (2) avian influenza viruses that are related to viruses known to cause severe disease in humans are of concern because of their perceived potential to cause severe disease in people. These include HPAI A (H5) and A (H7) viruses identified in birds in the United States during 2015 and 2016. Finally, (3) other avian influenza viruses may be deemed to be of public health concern based on specific circumstances.


This week the CDC has published guidance for those who may be exposed to birds that may be carrying avian flu. Again, this is primarily for those who work in the poultry industry who have been exposed to flocks determined to be infected with avian flu.



You are being given this information and these instructions because you were recently around poultry or wild birds found to be infected with avian influenza viruses (“bird flu”) of public health concern. Some avian influenza viruses have caused rare, sporadic infections in people, resulting in human illness ranging from mild to severe. These viruses are of public health concern because of their ability to cause human illness and also because of their potential to cause a pandemic.

Infected birds shed bird flu virus in their saliva, mucous and feces. Human infections with bird flu viruses are rare, but they can happen when enough virus gets into a person’s eyes, nose or mouth, or is inhaled. This can happen when virus is in the air (in droplets or possibly dust) and a person breathes it in, or when a person touches something that has virus on it and then touches their mouth, eyes or nose. Most often these infections have occurred after unprotected contact with infected birds or surfaces contaminated with avian influenza viruses. However, some infections have been identified where direct contact was not known to have occurred.

Because human infections with these viruses are possible, all people with exposure to birds infected with avian influenza viruses of public health concern and people with exposure to surfaces contaminated with these viruses should be monitored for illness for 10 days after their last exposure. State and local health departments are helping to monitor people’s health and you should contact your health department if you get any of the symptoms listed on this fact sheet during the 10 days after your last exposure. By following the instructions below, you can help ensure that you receive prompt medical evaluation, possible testing and appropriate treatment if you become ill with signs and symptoms that could be due to bird flu.

Please follow these instructions carefully:

1. Monitor your health for symptoms of avian influenza virus infection.
During and then immediately after your last exposure to infected birds or contaminated surfaces, monitor yourself daily for any of these signs and symptoms for 10 days:














You should observe your health daily even if you carefully followed all guidelines and instructions for properly putting on and taking off personal protective equipment (PPE) and maintaining biosecurity precautions.  

Re-start your 10-day monitoring period from Day 1 if you are around sick birds again.

2. Call your state/local health department immediately if you develop any illness signs or symptoms during the 10-day observation period.
Your health department will help you determine what to do next.

Remember: 

  • Most of the signs and symptoms of bird flu overlap with those of other respiratory illnesses (like seasonal flu).
  • If you develop any of the signs or symptoms listed on this fact sheet, immediately call the health department of the state you are in at the time. Your health department wants to hear from you, even if it turns out to be a ‘false alarm’.  
  • Your health department may contact you by phone, email or text while you are observing your health.
  • If you have symptoms, your health department may give you instructions and ask you to get tested for avian influenza virus infection.  
  • To test for avian influenza virus, a doctor or nurse will collect a sample from you by swabbing your nose and/or throat.
  • If you become sick while you are observing your health, a doctor may prescribe you an antiviral medication that is used for treatment of influenza.  It is important to follow the directions for taking the medication. (CDC recommends that clinicians prescribe antiviral medications for treatment of ill persons who had exposure to avian influenza viruses of public health concern.)













#10,946


There is a great deal we still don't know about the Zika virus, but given its suspected link to profound birth defects, public health agencies around the globe are faced with a difficult decision:

Do you wait for irrefutable proof of harm, or do you warn people based on the available (and often anecdotal) evidence, in hopes of preventing needless tragedies?

Given the devastating effects that microcephalic birth defects have on families and society, most health agencies would prefer to be proactive, even if it risks raising some degree of alarm. 

In this regard, this week the UK's PHE (Public Health England) has issued some specific advice to sexually active men who have recently returned from regions where Zika has been reported, based on limited reports that the virus may be sexually transmitted.

The notion that Zika might be transmitted direct contact first came to light in 2011 when the EID Journal carried a dispatch on the first Probable Non–Vector-borne Transmission of Zika Virus, Colorado, USA, involving two researchers infected in Africa, one of whom returned to the Untied States and passed the virus (presumably via sexual contact) on to his wife. 

This was the first instance where sexual transmission of an Arbovirus was suspected, the author’s writing:

Results also support ZIKV transmission from patient 1 to patient 3. Patient 3 had never traveled to Africa or Asia and had not left the United States since 2007. ZIKV has never been reported in the Western Hemisphere. Circumstantial evidence suggests direct person-to-person, possibly sexual, transmission of the virus.

A second clue came a year ago, when the CDC's EID journal carried a dispatch called:

Potential Sexual Transmission of Zika Virus


Didier MussoComments to Author , Claudine Roche, Emilie Robin, Tuxuan Nhan, Anita Teissier, and Van-Mai Cao-Lormeau

Abstract
In December 2013, during a Zika virus (ZIKV) outbreak in French Polynesia, a patient in Tahiti sought treatment for hematospermia, and ZIKV was isolated from his semen. ZIKV transmission by sexual intercourse has been previously suspected. This observation supports the possibility that ZIKV could be transmitted sexually.


Even if sexual transmission is possible, this would be a minor route of infection compared to the mosquito-vectored virus.  But as we've seen with Ebola in West Africa, some viruses can persist in the host long after they have physically recovered, and so this potential route of infection must be considered.


In addition to providing Zika virus: travel advice for pregnant women, this week the UK government updated their detailed guidance -  The characteristics, symptoms, diagnosis and epidemiology of Zika - with the following advice on sexual transmission of the virus.


Sexual transmission

Sexual transmission of Zika virus has been recorded in a limited number of cases, and the risk of sexual transmission of Zika virus is thought to be very low. However, if a female partner is at risk of getting pregnant, or is already pregnant, condom use is advised for a male traveller :
  • for 28 days after his return from a Zika transmission area if he had no symptoms of unexplained fever and rash
  • for 6 months following recovery if a clinical illness compatible with Zika virus infection or laboratory confirmed Zika virus infection was reported
This is a precaution and may be revised as more information becomes available. Individuals with further concerns regarding potential sexual transmission of Zika virus should contact their GP for advice.

The data is very limited, and the risks of sexual transmission are likely very low.  But there is still much we still don't know about how the Zika virus affects the human body, how it is shed, and the potential for non–vector-borne transmission of the virus.


For another look on how the Zika virus is shed from the human body, earlier today Dr. Ian Mackay looked at the detection of Zika virus in urine, in his VDU blog:

Zika virus disease samples...don't pass urine (by)..

Mosquito Bite Prevention for the United States PDF













#10,945



Amid the whirlwind of Zika related public health announcements yesterday (see WHO To Convene IHR Emergency Committee Meeting On Zika WHO Zika Media Briefing Audio Recording) the CDC held telebriefing of their own called ZIKA 101, featuring NIAID Director Dr Tony Fauci and the CDC's Principal Deputy Director Anne Schuchat, M.D..

Dr. Schuchat was the `voice' of the CDC during much of the opening months of the 2009 H1N1 pandemic, and impressed mightily with her ability to convey rapidly changing and unscripted information – while acknowledging  the things about the virus that were still unknown – in almost daily briefings.

For those unable to attend the CDC's event, we have a transcript posted to the CDC's media site late yesterday:


Thursday, January 28, 2016.

Please Note:This transcript is not edited and may contain errors.
OPERATOR: Welcome, and thank you for standing by.  At this time, all participants are in listen only mode.  After the presentation, we'll conduct a question and answer session.  To ask a question, please press the star and 1 and please record your name.  Today’s conference is being recorded.  If you have any objections, you may disconnect at this time.
 
TOM SKINNER: We’ll be joined today by DR.  Anne Schuchat, the Principal Deputy Director of the CDC and DR. Tony Fauci, Director of the National Institutes for Allergy and Infectious Diseases, both providing opening remarks about the current outbreak of Zika virus infection.  We understand we are getting a lot of calls and a lot of interest in this story right now.  We want to try to provide you all with as much information as we can, and so we're having this telebriefing.  I’ll turn the call over now to Dr. Schuchat. 
(Continue .. .)



Dr. Schuchat also penned a blog on Zika yesterday for the HHS.GOV website, which goes over the basics of Zika.

 
Summary: 
 
The Zika virus is spread to people through the bite of infected mosquitos. About 1 in 5 people who get infected with Zika virus will show symptoms.
 
In the past several weeks, increased cases of Zika virus disease (Zika) have been reported in South and Central America, and to a limited degree in the Commonwealth of Puerto Rico, a US territory, and the US Virgin Islands.  Zika is a little known illness spread by a certain type of mosquito. Although most people who may be exposed to Zika virus will have only mild or no symptoms, there has been evidence linking Zika virus to negative effects on pregnancies in some cases, which has received widespread public attention. We understand that this news is concerning, especially to pregnant women and their families who may travel to or live in affected areas. Here are some answers to common questions about Zika.

(Continue . . .)

Cara Membuat Roti Jala Resep Kuah Kari Daging Sapi
RESEP ROTI JALA KUAH KARI
Makanan yang berbentuk jala atau jaring ini sering disebut dengan roti jala atau roti kirai. Kuliner ini paling enak disantap bersama kuah kari sebagai ciri khasnya, bisa kari kambing, kari ayam, atau kari daging sapi dalam resep roti jala spesial kali ini. Roti jala dengan kuah kari sangat populer sebagai menu makanan melayu, india bahkan timur tengah. Di Indonesia sendiri cukup dikenal dengan roti jala khas Riau, Melayu Sumatera Utara hingga Aceh dengan bermacam variasinya.

Terdapat banyak kreasi dalam cara membuat roti jala yang mudah dan sederhana, di antaranya adalah penggunaan bahan utama telur atau tanpa telur, susu sebagai alternatif santan, atau dikombinasikan dengan bahan lainnya untuk menambah cita rasa. Begitu juga dengan variasi hidangannya, bisa dengan kuah durian, disuguhkan bersama saus coklat atau yang lain sebagainya.

Roti jala kari sapi juga tak kalah enaknya dengan aneka roti jala lainnya, sangat sedap disantap sambil menghirup kuah kari yang gurih dan ludes dalam sekejap.

Persiapan Bahan Roti Jala
  • 300 gram tepung terigu
  • 500 ml santan encer dari 150 gram kelapa parut
  • 4 butir telur
  • 4 sdm minyak sayur
  • 1 sdt garam
  • margarin secukupnya untuk olesan
Cara Membuat Roti Jala
  1. Campur dan aduk rata terigu dan garam dalam sebuah wadah. Masukkan telur dan aduk rata menggunakan whisk, lalu tuangkan santan dan minyak sayur. Aduk lagi hingga benar-benar rata, selanjutnya saring agar adonan tidak ada yang menggumpal.
  2. Masukkan adonan ke dalam wadah roti jala, plastik segitiga atau menggunakan botol plastik dan lubangi tutupnya sebesar sedotan kecil air gelas mineral, supaya nantinya bisa membentuk jala yang cantik saat adonan dituangkan.
  3. Panaskan teflon atau wajan anti lengket di atas api kecil, olesi tipis dengan margarin. Tuang adonan secara horisontal, vertikal dan melingkar-lingkar atau acak sesuai selera yang penting membentuk jala. Setelah adonan matang, lipat berbentuk segitiga atau dengan bentuk menurut selera.
Persiapan Bahan dan Bumbu Kari Daging Sapi
  • 250 gram daging sapi
  • 1,5 liter air untuk merebus daging
  • 600 ml santan dari 1 butir kelapa
  • 2 lembar daun salam
  • 2 lembar daun jeruk
  • 2 buah kapulaga
  • 4 butir cengkeh
  • 5 cm kayu manis
  • 1 buah pekak (bunga lawang)
  • 1/2 sdt pala bubuk
  • 1 sdt gula pasir
  • 1/2 sdt garam
  • minyak untuk menumis
Haluskan :
  • 6 buah cabe merah keriting
  • 6 butir bawang merah
  • 3 siung bawang putih
  • 4 butir kemiri
  • 4 cm jahe
  • 4 cm kunyit
  • 1 sdt adas manis
  • 1/2 sdt jinten
  • 1 sdm ketumbar
Cara Membuat Kuah Kari daging Sapi
  1. Cuci bersih daging sapi kemudian rebus dengan 1,5 liter air hingga empuk. Angkat dan tiriskan daging sapi lalu potong-potong dadu, sisihkan air rebusan untuk kuah kaldu.
  2. Panaskan sedikit minyak dan tumis bumbu halus hingga harum. Masukkan potongan daging beserta 500 ml kuah kaldu, masukkan juga daun salam, daun jeruk, kapulaga, cengkeh, kayu manis, pekak dan pala bubuk, serta aduk rata.
  3. Setelah mendidih, tuangkan santan lalu masak sambil diaduk-aduk hingga mendidih kembali. Tambahkan garam dan gula, aduk sesekali dan masak hingga matang.
Raffles Singapore Open House on 20th of February 2016

A great opportunity for students to explore Raffles creative learning environment, vibrant campus life and get in touch with our creative practitioners (lecturers) at Raffles College of Higher Education, Singapore. 
               
                       Date                      
20th of February 2016

                Time              
 10am – 5pm

           Venue        
  Raffles Education Square, 51 Merchant Road, Singapore 058283

      Programs
    Campus Tour
      Creative Design workshops
         Business workshops



For more information, please contact/visit your nearest JM Office today
                  
                                                                                                                                                 Article is courtesy of  Raffles College of Higher Education


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It is narrated on the authority of Amirul Mu’minin, Abu Hafs ‘Umar bin al-Khattab, radiyallahu ‘anhu, who said: I heard the Messenger of Allah, sallallahu ‘alayhi wasallam, say: “Actions are (judged) by motives (niyyah) , so each man will have what he intended. Thus, he whose migration (hijrah) was to Allah and His Messenger, his migration is to Allah and His Messenger; but he whose migration was for some worldly thing he might gain, or for a wife he might marry, his migration is to that for which he migrated.” [Al-Bukhari & Muslim]

Abu Hamzah Anas bin Malik, radiyallahu ‘anhu, who was the servant of the Messenger of Allah, sallallahu ‘alayhi wasallam, reported that the Prophet, sallallahu ‘alayhi wasallam, said: “None of you truly believes (in Allah and in His religion) until he loves for his brother what he loves for himself.” [Al-Bukhari & Muslim]

About History

The urgent of reading history is that we become aware of his past life, progress and destruction of a nation, understand the wisdom behind the nation's history, feel the love, angry, sad, all within the scope of history. Because history is an art. Art is beauty. So people who do not know history, its own history, at least then he would not know the beauty of the wheel of life that applies to every person.

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