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Dr. Umar Zein Tropical Disease and Infection Clinic

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Umar Zein
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Menyikapi wabah Demam Berdarah Ebola Jurnal Kedokteran Methodist Vo No 7 Tahun 2014
Umar Zein
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Opportunistic infections are commonly found in HIV carriers who have a low immunity and at the AIDS stage. The causes are yeast, bacterial and viral as well as parasites, including the helminth infection. We report a 24 year-old female who had a CD4 <20 cells/ with a multiple opportunistic infections; cerebral toxoplasmosis, oral candidiasis, cryptosporodiosis, amoebiasis, and of Hymenolepsis nana. The clinical manifestations were fever, and chronic diarrhea. Metronidazole and albendazole were effective for amoebiasis, but not for other parasites infection. Keywords : AIDS - opportunistic infection - cryotosporodiosis - hymenolepiasis - amoebiasis
Umar Zein
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Tentang perkembangan kasus HIV/AIDS di Indonesia (Jurnal Kedokteran Methodist-Medan, Vol 5 No 5 Maret 2011
An outbreak of chikungunya fever had been reported in two villages in Pancur Batu Subdistrict, Deli Serdang District, Sumatra Utara Province. The survaillence study was conducted from 5 November 2005 until 7 December 2006 among 220 people who showed clinical symptoms and signs og chikungunya fever. Ten blood samples were sent to Research & Development Laboratory of Indonesian Ministry of Health, Jakarta for chikungunya serology test. The finding showed that nine samples that positive results. (Jurnal Kedokteran Methodist Vol.6 No.6 Maret 2013)
Hadiki Habib
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Peritoneal tuberculosis may lead to delayed diagnosis because of the nonspecific features such as fever, abdominal distension, abdominal tenderness, ascites, and weight loss. Here, wereported a case of prolonged fever and abdominal pain which was due to peritoneal tuberculosis. Initial examinations including acomplete blood test and serologic tests did not lead to the diagnosis. A final diagnosis was made by abdominal CT-scan and laparoscopy combined with histopathological studies. Antituberculous medications provided a good clinical response in this patient.
Umar Zein
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Umar Zein
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Morbilli (Measles) is an acute viral infections disease caused by a morbillivirus as the paramyxovirus family. The disease primarily affects children, but can also occur in adults. The risk of complications of Morbilli in adults over the age of 20 years is greater than in children. Similarly, the risk of death in adults greater than in children. Reported a case of uncomplicated adult morbilli with diagnosis just based on clinical signs and symptoms. The patient came on day 4 of fever with a rash that has spread throughout the body. Treatment was given Paracetamol 500 mg 3 x 1 and 3 x 1 tablet Domperidom Patients are encouraged to cleanse the body with a bath 3 times a day. Patient advised bed rest at home, giving fluid intake and adequate nutrition and symptomatic treatment. Hspitalization is required when there is interference of oral fluid intake or have complications such as diarrhea, pneumonia, ear infections, or encephalitis. Prevention of transmission required to avoid contact those patient with people that who are at risk to contracting. Keywords: morbilli - adult - symptomatics - treatment
Umar Zein
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Objectives: The prevalence of Type 2 diabetes mellitus (T2DM) continues to rise at an exponential rate around the world as well as in South-East Asia regions. This study compared the effect of metformin and dhawalsan-1 (Curanga fel-terrae [Lour.]) extract on metabolic and inflammatory characteristics in patients with newly diagnosed T2DM. Methods: In this preliminary study, consecutive sampling was used to select 24 newly diagnosed T2DM subjects to be randomly assigned into two groups: One group received metformin 3 × 500 mg/day and another group received dhawalsan-1 extract 2 × 100 mg/day, in a double-blind fashion. Clinical characteristics of the patients were assessed before and after the 12-week treatment period. Results: After the 12-week treatment, in metformin group, a significant decrease was noted in waist circumference (p=0.005), fasting plasma glucose (FPG; p=0.017), glycosylated hemoglobin (HbA1c) (p=0.021), and homeostasis model of assessment of β-cell function (HOMA-B; p=0.020). In dhawalsan-1 group, a significant decrease was noted in FPG (p=0.012), HbA1c (p=0.006), and HOMA-insulin resistance (p=0.033), and a significant increase was noted in adiponectin (p=0.008). No significant differences were found between metformin and dhawalsan-1 group in any measured clinical characteristic after 12 weeks. Conclusions: This preliminary study indicated that dhawalsan-1 (C. fel-terrae [Lour.]) extract was effective in improving metabolic characteristics and significantly increased adiponectin levels in patients with newly diagnosed T2DM. The improvement also seemed to be comparable with that of metformin. Yet, Further larger studies are required to confirm these promising results. © 2016, Innovare Academics Sciences Pvt. Ltd. All rights reserved.
Background: The apoptosis of microvascular endothelial cells causes plasma leakage in dengue haemorrhagic fever patients. The soluble Fas ligand is a protein with molecular weight of 40 kDa that acts as a mediator of apoptosis. This study aimed to prove whether soluble Fas ligand can be used as a potential marker to predict the severity of dengue infection by comparing the soluble Fas ligand levels in dengue fever (DF) and dengue haemorrhagic fever (DHF) patients early in the course of illness. Method: This was a prospective study. It included 42 dengue patients (22 DF patients and 20 DHF patients) and 20 healthy people as a control group. The soluble Fas ligand was measured by the enzyme-linked immunosorbent assay (ELISA). Result: Soluble Fas ligand was increased significantly (P < 0.001) in DHF patients (median = 130.19, IQR = 36.26) compared to DF patients (median = 104.73, IQR = 53.94) and the control group (median = 87.16, IQR = 24.91). Conclusion: Soluble Fas ligand can be used as a potential marker to predict the severity of dengue infection in the early course of the illness. However, a larger sample size and further objective studies are needed to confirm these findings.
Umar Zein
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Diare adalah buang air besar (defekasi) dengan tinja berbentuk cair atau setengah cair (setengah padat), Oleh UMAR ZEIN dkk. penydalam-umar5
Malaria merupakan masalah kesehatan dibanyak negara diseluruh dunia. Tiga ratus juta penduduk diserang setiap tahunnya dan 2-4 juta meninggal dunia 1. Indonesia merupakan daerah endemis malaria, walaupun telah dilakukan program pelaksanaan dan pemberantasan penyakit malaria sejak tahun 1959, namun hingga saat ini angka kesakitan dan kematian masih cukup tinggi 2. pd-umar5
Umar Zein
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Harian Waspada Medan, 19 November 2017
 
Umar Zein
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Umar Zein
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Kejadian Luar Biasa (KLB) atau wabah Demam Berdarah Dengue (DBD) di Medan khususnya dan Sumatera Utara pada umumnya, Oleh UMAR ZEIN penydalam-umar
Malaria merupakan masalah kesehatan dibanyak negara diseluruh dunia. Tiga ratus juta penduduk diserang setiap tahunnya dan 2-4 juta meninggal dunia, Oleh UMAR ZEIN penydalam-umar6
Umar Zein
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Aim: to compare the anti-malarial effect among sambiloto extract, chloroquine and artemisinin-only as well as those of their combination. Methods: the study was conducted in Central Biomedical Laboratory, Faculty of Medicine, Brawijaya University, Malang, Indonesia from January to February 2006. Malaria culture used Plasmodium falciparum of Papua strain (2300) that was obtained from Namru-2 Jakarta. Five drugs applied in this test; those were chloroquine, artemisinin, the extract of sambiloto, the combination of sambiloto and chloroquine, and the combination of sambiloto and artemisinin. Parasite density was determined by counting the number of Plasmodium falciparum infected erythrocyte in 5,000 erythrocytes of the culture. Single drug (Chloroquine-only or artemisinin only) and either combination with sambiloto at dose 0.5 ug/ml had killing-effect against the parasite, measured by the appearance of "crisis form" on the infected erythrocytes. This killing-effect was dose dependent, and reached its optimum effect of 200 ug/ml. Results: treatment of single sambiloto extract with dose 0.5 ug/ml increased the density of the parasite, however after every 1ug increasing dose of sambiloto extract, the killing effect also increased. The reduction of the parasite density was also seen by increasing the Sambiloto dose in the group of combination of sambiloto-chloroquine as well as the group of combination of sambiloto and artemisinin. Statistically, there was no difference in the anti-malaria efficacy among of five test drugs (p=1.00). The correlation between the reduction of the parasite with the increasing of dose in all groups is statistically significance (p=0.001). Conclusion: the extract of sambiloto in a single dose or in a combination evidently has the effect of anti-falciparum malaria.
Skin lesion is common in person living with HIV. We reported a 42 years old HIV positive man with single erythema skin lesion on the right foot. Clinical examination, anamnesis and laboratory examination revealed that it was cutaneous larva migrant due to parasitic infection. The cutaneous larva migrant due to hookworms is one of neglected tropical disease that might occur in adult with immunocompromised. This neglected disease is discussed rarely and might not be found in developed country, but it is still a common disease in the tropical region. Patient was treated successfully with albendazole, cetirizine, chlorethyl spray and betamethasone cream.
Umar Zein
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ABSTRACT Background: The increase of Plasmodium falciparum resistance to antimalarial drugs compelled us to look for alternative treatment that may be locally available in Indonesia and could posses an antimalarial action and eventually be developed later on. The sambiloto (Andrographis paniculata Nees) is one of the herbals that could be found in all parts of Indonesia. This herbal has been used for infectious diseases in Asia for centuries. Materials and Methods: An in vitro study was conducted using the Plasmodium falciparum Papua strain culture at Biomedical Laboratory, Faculty of Medicine, Brawijaya University, Malang with trial drugs like chloroquin, artemisinin, sambiloto extract, and combination of sambiloto extract with either chloroquin or artemisinin. A clinical study was also conducted in Mandailing Natal District of North Sumatera Province in randomized, double-blind controlled manner with four groups of treatment regimens in adult falciparum malarial patients without complications. Patients were administered the extract of herbal sambiloto 250 mg (n = 40) or 500 mg (n = 38) monotherapy thrice daily for five days or in combination of sambiloto extract 250 mg with either chloroquin 1.000 mg on day 1 and day 2 and 500 mg on day 3 (n = 37) or artesunate 200 mg daily for three days (n = 40). We also monitored the adverse effects, hematology and blood chemistry and plasma levels of TNF-α and IFN- γ to assess the immunomodulatory actions. Results: In vitro study of chloroquin showed that the killing effect of parasite by its ”crisis form” in culture cells occurred after 48 hour in a dosage of 0.5 ug/ml. In the sambiloto group the killing effect was seen at a higher dosage (1 ug/ml). The combination of sambiloto and artemisinin has also the killing effect in a dosage of 0.5 ug/ml. The antimalarial efficacy of sambiloto 250 mg or 500 mg, respectively, and the combination of sambiloto 250 mg and chloroquin or artesunate were 90.9%, 90.5%, 90.2% and 95.2%, respectively (p>0.3). The plasma level of TNF-α increased on day 7 with sambiloto 500 mg (p<0.05). Sambiloto extract for five days had no adverse effects on liver and kidney functions and on hematological post treatment effect as well (p>0.3). Conclusions: Sambiloto extract has an antimalarial effect in in vitro and in vivo studies. The efficacy of sambiloto extract 250 mg and 500 mg was equivalent. The combination of sambiloto and artesunate showed the highest efficacy. Sambiloto extract 500 mg had an immunomodulatory action. Keywords: Sambiloto – artesunate – antimalaria - TNF-α – immunomodulatory effect
Umar Zein
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A 50-year old man was consulted due to right leg swelling concomitant with redness and pain since two months between admission. The patient experienced fever and dull pain in right inguinal region before the leg became swollen. Antibiotic and antipyretic had been given but gave unsatisfaction response. No history of bedridden, hospitalization, or malignancy. He worked as a palm oil farmer in Geragas Village,langkat District, North Sumatera, Indonesia, an endemic region of Bancroftian filariasis. Physical examination revealed normal vital signs, there was non pitting oedema and redness in right gastrocnemius region (Figure 1). Laboratory results of routine blood count and haemostasis were within normal limit, except leucocytosis (12000/m3) and eosinophilia (15%). Peripheral blood sample was drawn between 10 pm and 2 am and showed positive microfilariae with gently curved body, a tail that is tapered to a point, and the nuclear column is loosely packed, appropriate for Wuchereria bancrofti (Figure 2).Patient’s diagnosis was acute lymphangitis due to filariasis of W. bancrofti. Treatment was based on protocol in Cunha (2010)
Ovale malaria cases in Indonesia have been reported only in the provinces of Papua, East Timor and West Flores. We have found a case of Plasmodium ovale infection in Langkat District, North Sumatra Province. Diagnosis was based on a complaint of recurrent fever accompanied by chills and intermittent fever and confirmed by Giemsa-stained microscopic examination of thick and thin peripheral blood smears. The characteristic morphology of Plasmodium ovale in blood smear determined the patient’s diagnosis. Thus, a new endemic areas of ovale malaria was discovered in Indonesia.