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saco-indonesia.com, Kanker hati primer merupakan penyakit di mana sel kanker yang tumbuh berasal dari organ hati. Beberapa tipe kanker hati primer telah diberi nama sesuai dengan asal tumbuh sel kanker tersebut. Hepatocellular carcinoma (HCC) atau dikenal hepatoma yang tumbuh dari sel utama hati yang disebut hepatocytes dan juga merupakan 85% dari kasus kanker primer. Jenis kanker hati primer yang tidak begitu umum terjadi berasal dari sel berada pada garis saluran empedu yang disebut cholangiocytes, sehingga kanker tipe ini juga lebih dikenal sebagai kanker cholangiocarcinoma atau kanker saluran empedu.

Organ hati juga merupakan tempat dari tumbuhnya satu tipe kanker yang disebut kanker hati sekunder (kanker metastatik). Pada kondisi ini kanker utama sebenarnya berasal dari bagian tubuh yang lain dan telah membentuk deposit sekunder pada hati. Contoh umum dari kasus yang sering terjadi adalah kanker kolorektal yang telah menyebar ke organ hati melalui pembuluh darah.

Umumkah Kanker Hati?

Secara global, kanker hati primer umumnya telah terjadi pada pria dua kali lipat lebih sering dibandingkan pada wanita. Kanker hati juga merupakan kanker paling umum urutan ke-5 dan ke-7 bagi pria dan wanita. Negara-negara Asia juga mempunyai 80% pasien kanker hati primer secara global di mana sekitar 600.000 kasus terdiagnosa setiap tahunnya.

Apa yang menjadi faktor resiko penyebab kanker hati?

Terdapat tiga faktor utama yang dapat menyebabkan tumbuhnya HCC (kanker hati primer paling umum) yaitu infeksi kronis Hepatitis B, infeksi kronis Hepatitis C, dan konsumsi alkohol yang berlebihan. Resiko bagi individual dengan infeksi kronis Hepatitis B untuk terkena HCC adalah 100x dari individu normal.

Faktor lain yang dapat menjadi resiko meliputi aflatoxin (racun yang telah ditemukan pada kacang yang berjamur, gandum, dan kedelai), kondisi yang telah diwariskan (misal haemochromatosis, defisiensi alpha-1 anti-trypsin) dan penyebab cirrhosis (luka sepanjang hati) seperti hepatitis autoimun atau primary biliary cirrhosis. Banyak kanker hati juga dapat dicegah melalui peran masyarakat dalam mengurangi paparan terhadap faktor-faktor resiko yang telah diketahui.

 
Apa saja gejala-gejala kanker hati

Pasien yang terkena HCC biasanya tidak memiliki gejala-gejala yang berbeda dengan penyakit hati kronik lainnya. Dengan gejala yang memburuk dari penyakit hati kronis seperti pembengkakan perut akibat cairan (ascites), encephalopathy (berubahnya kondisi mental), sakit kuning, atau pendarahan pada sistem saluran pencernaan dapat meningkatkan kemungkinan berkembangnya HCC. Disamping itu, beberapa pasien juga mungkin merasakan rasa nyeri pada perut bagian atas, kehilangan berat badan, mudah kenyang, letih lesu, anoreksia, atau benjolan yang dapat dirasakan pada perut bagian atas.

 
Apakah dapat dilakukan skrining untuk kanker hati

Ya, skrining juga dapat membantu dokter untuk dapat menemukan dan mengobati HCC sedini mungkin, saat kanker masih setempat saja dan lebih mudah diangkat melalui proses bedah. Hal ini juga dapat meningkatkan tingkat keselamatan. Mereka yang telah mengidap infeksi Hepatitis B kronis dan luka hati (cirrhosis) karena hepatitis C atau sebab lain memiliki resiko tinggi terkena penyakit ini dan harus melalukan skrining guna untuk mendeteksi kanker hati.

Proses skrining meliputi:

    Tes darah untuk alpha-fetoprotein (AFP) 3-6 bulan sekali.
    Scan ultrasound pada bagian hati 6-12 bulan sekali.

 
Diagnosis dan Penilaian
          

Bagaimana proses diagnosa kanker hati?

Rangkaian tes dan prosedur berikut bisa dilakukan untuk dapat mendiagnosa HCC dan untuk dapat menunjukkan stadium kanker:

    Pemeriksaan fisik untuk kesehatan secara umum. Pemeriksaan bagian perut dilakukan untuk dapat mendeteksi adanya gumpalan keras atau ascites.
    Tes darah untuk kesehatan secara umum, fungsi hati dan jumlah/kadar AFP. Jumlah AFP pada penderita HCC lebih tinggi daripada pada orang normal.
    Scan ultasound pada hati dengan menggunakan gelombang suara untuk dapat menghasilkan citra hati. Prosedur tes ini juga tidak menimbulkan rasa sakit dan hanya perlu beberapa saat untuk dapat dilakukan. Citra yang dihasilkan dapat menunjukkan ada tidaknya tumor pada hati.
    Scan pencitraan Tomografi terkomputasi (CT) atau Magnetic Resonance Imaging (MRI) pada bagian perut juga akan memberikan gambar 3 dimensi dari hati. Gambar tersebut juga dapat menunjukkan ukuran dan posisi tumor, serta penyebarannya.

            
Walau diagnosa HCC dapat dibuat berdasarkan kadar AFP dalam darah dan pada hasil scan CT atau MRI, biopsi hati kadang kala juga perlu dilakukan untuk dapat memastikan hasil diagnosa. Bila kanker belum dapat menyebar dan masih dapat diangkat, maka biopsi tidak perlu dilakukan. Hal ini juga disebabkan oleh adanya resiko kecil penyebaran kanker sebagai akibat dari pengangkatan kanker oleh jarum biopsi. Pada situasi seperti ini, diagnosa dipertegas setelah bedah pengangkatan tumor.

 
Pengobatan dan Perawatan

Bagaimana cara mengobati kanker hati?

Tipe pengobatan untuk pasien kanker hati sangat tergantung pada stadium kanker (yaitu ukuran dan tingkat penyebaran kanker) dan kondisi kesehatan pasien secara umum. Prosedur pengobatan utama yang digunakan adalah bedah, ablasi tumor, kemoterapi, terapi kanker terarah dan radioterapi.
Pembedahan
          
Ablasi tumor

Pembedahan telah memiliki potensi penyembuhan dan juga merupakan prosedur pengobatan pilihan untuk pasien dengan HCC tahap dini. Bila hanya bagian tertentu dari hati yang terkena kanker dan bagian hati lainnya sehat, maka prosedur bedah juga dapat dilakukan untuk bisa mengangkat bagian yang terkena kanker. Prosedur bedah tipe ini juga disebut reseksi hati. Bentuk prosedur lain dari pembedahan adalah cangkok hati. Prosedur ini telah melibatkan pengangkatan seluruh organ hati dan menggantinya dengan organ hati donor yang masih sehat. Prosedur bedah besar seperti ini telah dilakukan bila kanker hanya terdapat pada hati dan donor hati tersedia. Bila prosedur bedah tidak memungkinkan, maka metode pengobatan lain akan diberikan guna untuk mengendalikan pertumbuhan kanker, dengan begitu mengurangi efek/gejala kanker serta meningkatkan kualitas hidup pasien.
          

Ablasi tumor bertujuan untuk dapat menghancurkan sel kanker hati primer dengan menggunakan panas (ablasi frekuensi radio: RFA) atau dengan alkohol (percutaneous ethanol injection; PEI). Prosedur ini umumnya hanya dilakukan di departemen scanning dimana ultrasound atau CT dapat membantu dokter untuk dapat mengarahkan jarum melalui kulit dan masuk ke dalam kanker yang berada di hati. Prosedur ini juga menggunakan anastesi lokal. Pengobatan RFA dengan menggunakan sinar laser atau gelombang radio yang dihantarkan melalui jarum menuju kanker guna untuk menghancurkan sel kanker. Pengobatan PEI dengan mengunakan alkohol yang disuntikkan masuk melalui jarum untuk dapat menghancurkan sel-sel kanker. Ablasi tumor juga dapat dilakukan berulang-ulang apabila tumor kembali tumbuh.
            
Kemoterapi
          
          
Kemoterapi adalah penggunaan obat-obatan anti kanker untuk dapat menghancurkan sel kanker atau menghentikan pertumbuhannya. Prosedur ini juga dapat membantu mengendalikan kanker dengan menyusutkan kanker serta memperlambat pertumbuhannya. Obat-obatan kemoterapi pada umumnya telah diberikan melalui suntikan pada pembuluh darah (secara intravena), walau terkadang dapat pula diberikan dalam bentuk tablet. Kemoterapi juga dapat diberikan sebagai bagian dari pengobatan yang disebut kemo embolisasi. Porses kemo embolisasi juga melibatkan suntikan obat kemoterapi langsung pada kanker dalam hati, bersamaan dengan sebuah jel atau titis plastik kecil untuk dapat menghambat aliran darah menuju kanker (embolisasi). Tidak semua pasien dapat menjalani prosedur kemoterapi ini karena prosedur ini telah memerlukan hati yang masih bisa berfungsi dengan baik.
            
Terapi kanker terarah
          
Radioterapi

Terapi kanker terarah (Targeted Cancer Therapy) dengan menggunakan obat-obatan atau pengobatan lainnya untuk dpat mencegah pertumbuhan serta penyebaran kanker dengan melakukan interfensi pada molekul tertentu yang terlibat dalam pertumbuhan kanker. Satu obat untuk terapi kanker terarah bernama Sorafenib dapat digunakan untuk dapat mengobati pasien dengan HCC tahap lanjut. Sorafenib menyerang kanker dengan cara mencegah kanker mengembangkan pembuluh darahnya sendiri. Sel kanker juga memerlukan asupan darah untuk dapat membawa nutrisi dan oksigen. Sorafenib juga berfungsi untuk dapat membatasi kemampuan kanker untuk berkembang. Sorafenib telah melalui dua uji klinis besar pada pasien dengan HCC tahap lanjut, dibandingkan dengan mereka yang dirawat hanya dengan perawatan pendukung. Sorafenib adalah tablet yang umumnya diberikan 2 kali sehari. Efek samping yang diberikan termasuk diare, cepat letih, mual dan tekanan darah tinggi.
          

Radioterapi dengan menggunakan sinar energi tinggi untuk dapat menghancurkan sel kanker atau menghentikan pertumbuhannya. Radioterapi eksternal dengan menggunakan mesin yang digunakan secara eksternal dari tubuh untuk dapat menghantarkan radiasi pada kanker. Prosedur pengobatan ini juga jarang digunakan pada penderita kanker HCC karena hati tidak dapat terpapar oleh radiasi tinggi. Namun, prosedur ini juga dapat mengurangi rasa sakit, seperti misalnya pada pasien yang kankernya telah menyebar hingga ke tulang. Sebagai prosedur alternatif, radiasi internal yang menggunakan zat radioaktif dihantarkan secara selektif menuju kanker melalui pembuluh darah arteri yang mengantarkan darah ke hati.

 
Apakah kanker hati dapat dicegah?

Tentu saja. Ada beberapa hal yang dapat kita lakukan untuk dapat mencegah kanker hati:

    Vaksinasi terhadap virus hepatitis B
    Hindari mengkonsumsi bahan-bahan yang mengandung karsinogen hati, khususnya alkohol.
    Hindari daging berlemak dan lemak hewani. Hindari kacang dan gandum berjamur.
    Lakukan skrining secara regular bila Anda termasuk dalam kelompok dengan resiko kanker yang tinggi

 
Dukungan apa yang tersedia?
          

CanHOPE, adalah badan non-profit yang bergerak di bidang layanan konseling dan dukungan terhadap penderita kanker yang diprakarsai oleh Parkway Cancer Centre.

Sebagai bagian dari sebuah pendekatan holistik untuk dapat mengobati kanker, CanHOPE juga bekerjasama dengan tim medis dan ahli-ahli kesehatan professional yang telah menawarkan sumber daya serta informasi yang luas mengenai kanker untuk dapat membantu pasien dan keluarga mereka agar dapat mengambil keputusan yang tepat selama perjalanan mereka menuju kesembuhan.


Editor : dian sukmawati

KANKER HATI
Dalam cinta yang murni dibutuhkan kepercayaan, adakalanya kekuatan cinta mencipta rasa saling menyakiti. Namun dengan kekuatannya pula, cinta yang murni tak membiarkan itu terjadi.
Harus Dibedakan mana cinta sejati dan mana cinta yang dihiasi kepalsuan. Satu-satunya cinta sejati yang sangat mudah kita temui, adalah cinta seorang ibu pada anaknya.
Dalam Cinta sejati terkadang menimbulkan luka. Dan luka karenanya selalu membuat diri lebih dewasa.
Mustahil engkau merasakan cinta tanpa pernah merasakan sakit dan pengkhianatan. Sebab cinta sejati dapat engkau temui jika telah merasa perih dan luka didada.
Kesetiaan ibarat mahkota bertahta intan permata, ketika engkau mengabaikannya, hilanglah sudah keagungan dan kemewahan diri.
Jangan terlemahkan oleh angin permasalahan. Layang-layang mampu terbang tinggi karena berani melawan angin. Hanya layang-layang yang putus benang yang hanyut oleh angin.
Yang paling menyakitkan dalam sebuah hubungan adalah pengkhianatan, dan lebih menyakitkan lagi ketika yang melakukannya adalah orang yang paling anda percayai.
Percayalah bahwa sebuah senyum meskipun saat terluka, akan lebih mempesona dibandingkan tertawa yang dipenuhi kemunafikan.
Jangan hanya karena engkau merasa kaya raya lalu bisa membeli sebuah kebahagiaan dan cinta yang suci. Kebahagiaan dan Cinta tidak serta merta anda dapatkan dengan kekayaan, melainkan dengan perasaan yang tulus dan menerima takdir Ilahi dengan kerelaan hati
Kebahagiaan yang diukur dengan harta melimpah ruah bukan lah sesuatu yang salah. Namun berucap syukur atas segala yang Tuhan beri adalah kebahagiaan sejati.
Masa-masa terbaik dalam hidup adalah saat kita mampu menyelesaikan masalah sendiri, Masa-masa suram kehidupan adalah saat kita menyalahkan orang lain atas masalah yang kita hadapi.
Ketika dalam sebuah persimpangan, anda diharuskan memutus sebuah langkah. Pastikan langkah yang diambil adalah demi kebahagiaannya, meskipun rasa sakit yang kan kita terima.
Musafir yang dahaga di gurun pasir masih bisa bertahan. Namun jika hati yang dahaga akan cinta bisa mati perlahan dalam kesepian
Jangan berkata, “kamu pasti bahagia jika bersamaku”, tapi berkatalah, “Selagi nafas ada dalam diri, kebahagiaanmu adalah prioritasku”.
Hidup adalah memilih, namun untuk memilih dengan baik, Anda harus tahu siapa Anda dan apa yang Anda perjuangkan, ke mana Anda ingin pergi dan mengapa Anda ingin sampai di sana.
Tuhanmu lebih tahu batas rasa sakit yang bisa kau tampung. Jangan sampai engkau menyerah disaat selangkah lagi Tuhanmu mengganti kesakitan dengan sejuta keindahan.
 
Beberapa yang mampu diselami, adalah wanita begitu sangat susah dipahami. Terkadang telah sejuta makna kita berikan, yang ada tetap misteri hati yang kita dapati.
Seseorang tak akan pernah bisa mencintai Anda dengan tulus dan apa adanya, jika Anda selalu menyembunyikan kekurangan Anda darinya.
Pernahkah anda di permalukan seorang wanita gara-gara anda mengatakan setulus hati anda mencintainya? Jika YA, anda lah orang paling beruntung di dunia, karena anda mampu mengungkapkan sebuah kejujuran. Dan wanita itu tak lebih seperti patung liberty, terlihat indah namun tak mampu menyelami makna cinta yang suci.
 
Berapa kali anda di kecewakan olehnya? Tahukah, setiap kekecewaan yang anda rasa, ibarat bunga yang sedang berkembang menuju sempurna. Semakin anda menerima dengan tulus hati, bunga-bunga indah tersebut akan semakin menampakkan diri. Meskipun bisa saja, anda memetiknya bukan dengannya lagi, tapi dengan orang lain yang paham arti menghargai.
Tidak seorang pun punya kemampuan untuk melakukan sesuatu hal sempurna, tapi setiap orang diberi banyak kesempatan untuk melakukan hal yang benar.
Putus asa adalah sebuah episode ter-gelap dalam hidup. Terkadang untuk menyambungnya menjadi harapan baru dibutuhkan sebuah cinta yang benar-benar murni. Salah satu cara sederhana mendapatkannya, adalah dengan menerima takdir yang telah Tuhan beri.
Ketika engkau merasa dunia sangat tak adil terhadapmu. Pikirkanlah, ribuan anak di kolong jembatan berharap bisa berada dalam posisimu.
Satu-satunya cara untuk melakukan pekerjaan besar adalah dengan mencintai apa yang Anda lakukan, walaupun sebenarnya anda membencinya.
Cinta antara dua hati seharusnya membebaskan kita dari segala yang mengekang. Bukan malah membuat kita terkungkung. Memang tak bisa disalahkan, namun harus jujur di akui, konsekuensi dari cinta membuat kita harus pandai-pandai menjaga lisan, mata dan terlebih kesetiaan.
baca selengkap nya klik di sini
 
TENTANG CINTA

saco-indonesia.com, Menantang duel tetangga, seorang jagoan kolot alias jagoan tua, tewas dengan luka bacokan, setelah sempat memutuskan lengan lawannya itu.

Damiri yang berusia 60 tahun , warga Dusun Dua, Desa Bojong, Kecamatan Sekampung Udik, Kabupaten Lampung Timur, tewas dengan tubuh penuh luka bacokan

Sebelumnya, sang jagoan telah mendatangi tetangganya Anom yang berusia 60 tahun , lalu menantangnya berkelahi dengan menggunakan parang.

Warga yang menyaksikan ketakutan setelah melihat tangan kiri Anom putus terkena sabetan golok Damiri . Namun tanpa disangka Anom yang dengan sisa tangan satu yang dimiliki malah balik melakukan sabetan setelah melihat kesempatan membacok leher lawannya sehingga sang jagoan tak ayal tersungkur tewas di tempat dengan penuh luka bacokan.

Menurut Hasanudin, tokoh masyarakat Desa Bojong, perkelahian antar tetangga itu bermula dari Damiri yang berteriak-teriak di depan rumah Anom menantang Anom sekitar pukul 07. 00 WIB.pagi.

Anom pun keluar dari rumah membawa golok. “Warga tidak berani melerai karena Damiri di desa mereka dikenal sebagai jagoan dan cenderung pemarah. Warga hanya bisa menonton saat mereka semua jatuh dengan badan penuh bacokan,” kata Hasanudin

Kasat Reskrim Polres Lampung Timur,  Iptu Zaldi Kurniawan juga mengatakan korban perkelahian antar tetangga itu satu tewas lainnya luka parah tangan kanannya putus dan kini telah menjalani perawatan di Rumah Sakit Umum Daerah Abdoel Moeluk, Bandarlampung.

“Saat ini kami juga masih memeriksa saksi-saksi untuk dapat mengungkap motif perkelahian maut tersebut,” ujar Kasat Reskrim.


Editor : Dian Sukmawati

JAGOAN TUA TEWAS DI TANGAN TETANGGA

saco-indonesia.com, Agung Rizki yang berusia 20 tahun , yang merupakan tersangka pembunuh Aan Aminah telah mengaku sakit hati pada korban karena selama ini telah diperlakukan seperti budak disuruh ngepel, cuci baju dan memijit korban di rumah kos tersebut.

Menurut tersangka yang juga mengaku pacar korban, karena ulah janda satu anak itu sudah keterlaluan, maka pada Selasa (24/12) malam sekitar Pk 19;00, pelaku telah menusuk rusuk kanan korban empat kali. Tak puas menusuk korban , Agung Rizki lalu mencekik kekasihnya hingga tewas.

Menurut Kapolsek Tamansari Kompol Adi Vivid AB, pengakuan dari tersangka tadi baru pemeriksaan sementara. “Kami juga masih terus memeriksa tersangka berkaitan hilangnya harta benda milik korban,” ujar kapolsek yang telah menambahkan bahwa kasus pembunuhan itu telah dilimpahkan ke Polres Metro Jakarta Barat.

Sebagaimana yang telah diketahui, Aan Aminah telah ditemukan tewas dalam kondisi bugil tapi ditutupi pelaku pakai bedcover di rumah kosnya di Jalan Mangga Besar 9 RT012/07 Kel Tangki, Kec. Tamansari, Jakarta Barat, Jumat (27/12) malam lalu.

Korban setelah dihabisi ditinggal pelaku dengan cara kamar digembok dari luar. Baru setelah mayat wanita itu membusuk ditemukan warga.


Editor : Dian Sukmawati

PEMBUNUH WANITA DI KAMAR KOS MENGAKU SAKIT HATI

Saco-Indonesia.com - Sebuah diet yang seimbang dan sehat mampu memberikan banyak suntikan nutrisi untuk tubuh Anda. Diet yang seimbang tidak hanya dapat membantu untuk menurunkan berat badan Anda, namun juga mampu menyehatkan pencernaan, membersihkan tubuh dari racun, dan juga meningkatkan sistem kekebalan tubuh Anda.

Apabila Anda merasa bosan dengan variasi sayur dan buah yang selama ini Anda konsumsi, tidak ada salahnya apabila Anda mencoba untuk mengonsumsi makanan pahit berikut. Makanan pahit walaupun memiliki rasa yang tidak terlalu menyenangkan, namun makanan ini mengandung banyak sekali senyawa alami yang menguntungkan kesehatan Anda.

Inilah makanan pahit yang baik untuk kesehatan seperti dilansir dari boldsky.com.

Pare
pare mengandung zat antioksidan yang khas yaitu phyto-konstituen. Bersama dengan vitamin, mineral, dan serat, zat ini mampu menyembuhkan dari penyakit kolera, diabetes melitus, gangguan mata, gangguan tidur, dan sembelit. Pare juga mampu membersihkan darah Anda dari berbagai macam racun.

Kunyit
Kunyit merupakan salah satu jenis rempah-rempah yang memiliki kemampuan penyembuhan yang luar biasa. Kunyit yang seringkali dimasukkan ke dalam pembuatan jamu ini mampu membersihkan darah, mencegah batu empedu, menyehatkan sistem pencernaan dan juga hati Anda.

Cokelat hitam
Cokelat yang diolah tanpa pemanis buatan ini dapat meningkatkan kebutuhan serat dan tembaga di dalam tubuh Anda. Nutrisi ini mampu menjaga kesehatan darah dan mengontrol tekanan darah.

Jintan
Jintan adalah rempah-rempah yang kaya akan vitamin E yang dapat meningkatkan kesehatan kulit Anda. Jintan juga mampu menjaga asetilkolin yang bermanfaat untuk meningkatkan fungsi otak dalam menyimpan memori.

Biji wijen
Walaupun kecil, namun biji wijen merupakan sumber yang baik untuk mencukupi kebutuhan mangan, tembaga, kalsium, magnesium, beri dan fosfor yang bermanfaat untuk memerangi sakit rheumatoid, mencegah tekanan darah tinggi, dan melindungi usus besar dari kanker.

Terung
Fitonutrien adalah nutrisi penting yang ada di dalam terung. Terung juga sumber dari vitamin K, tembaga, vitamin C, folat, dan niasin. Semua nutrisi ini baik untuk meningkatkan kesehatan darah dan tulang.

Makanan sehat dapat berasal dari mana saja termasuk dari makanan yang memiliki rasa pahit. Anda tertarik untuk mencobanya?

Editor : Maulana Lee

Sumber :merdeka.com

Enam Makanan pahit yang membawa dampak manis untuk kesehatan

Ms. von Furstenberg made her debut in the movies and on the Broadway stage in the early 1950s as a teenager and later reinvented herself as a television actress, writer and philanthropist.

Betsy von Furstenberg, Baroness and Versatile Actress, Dies at 83

Mr. Fox, known for his well-honed countrified voice, wrote about things dear to South Carolina and won over Yankee critics.

William Price Fox, Admired Southern Novelist and Humorist, Dies at 89

From sea to shining sea, or at least from one side of the Hudson to the other, politicians you have barely heard of are being accused of wrongdoing. There were so many court proceedings involving public officials on Monday that it was hard to keep up.

In Newark, two underlings of Gov. Chris Christie were arraigned on charges that they were in on the truly deranged plot to block traffic leading onto the George Washington Bridge.

Ten miles away, in Lower Manhattan, Dean G. Skelos, the leader of the New York State Senate, and his son, Adam B. Skelos, were arrested by the Federal Bureau of Investigation on accusations of far more conventional political larceny, involving a job with a sewer company for the son and commissions on title insurance and bond work.

The younger man managed to receive a 150 percent pay increase from the sewer company even though, as he said on tape, he “literally knew nothing about water or, you know, any of that stuff,” according to a criminal complaint the United States attorney’s office filed.

The success of Adam Skelos, 32, was attributed by prosecutors to his father’s influence as the leader of the Senate and as a potentate among state Republicans. The indictment can also be read as one of those unfailingly sad tales of a father who cannot stop indulging a grown son. The senator himself is not alleged to have profited from the schemes, except by being relieved of the burden of underwriting Adam.

The bridge traffic caper is its own species of crazy; what distinguishes the charges against the two Skeloses is the apparent absence of a survival instinct. It is one thing not to know anything about water or that stuff. More remarkable, if true, is the fact that the sewer machinations continued even after the former New York Assembly speaker, Sheldon Silver, was charged in January with taking bribes disguised as fees.

It was by then common gossip in political and news media circles that Senator Skelos, a Republican, the counterpart in the Senate to Mr. Silver, a Democrat, in the Assembly, could be next in line for the criminal dock. “Stay tuned,” the United States attorney, Preet Bharara said, leaving not much to the imagination.

Even though the cat had been unmistakably belled, Skelos father and son continued to talk about how to advance the interests of the sewer company, though the son did begin to use a burner cellphone, the kind people pay for in cash, with no traceable contracts.

That was indeed prudent, as prosecutors had been wiretapping the cellphones of both men. But it would seem that the burner was of limited value, because by then the prosecutors had managed to secure the help of a business executive who agreed to record calls with the Skeloses. It would further seem that the business executive was more attentive to the perils of pending investigations than the politician.

Through the end of the New York State budget negotiations in March, the hopes of the younger Skelos rested on his father’s ability to devise legislation that would benefit the sewer company. That did not pan out. But Senator Skelos did boast that he had haggled with Gov. Andrew M. Cuomo, a Democrat, in a successful effort to raise a $150 million allocation for Long Island to $550 million, for what the budget called “transformative economic development projects.” It included money for the kind of work done by the sewer company.

The lawyer for Adam Skelos said he was not guilty and would win in court. Senator Skelos issued a ringing declaration that he was unequivocally innocent.

THIS was also the approach taken in New Jersey by Bill Baroni, a man of great presence and eloquence who stopped outside the federal courthouse to note that he had taken risks as a Republican by bucking his party to support paid family leave, medical marijuana and marriage equality. “I would never risk my career, my job, my reputation for something like this,” Mr. Baroni said. “I am an innocent man.”

The lawyer for his co-defendant, Bridget Anne Kelly, the former deputy chief of staff to Mr. Christie, a Republican, said that she would strongly rebut the charges.

Perhaps they had nothing to do with the lane closings. But neither Mr. Baroni nor Ms. Kelly addressed the question of why they did not return repeated calls from the mayor of Fort Lee, N.J., begging them to stop the traffic tie-ups, over three days.

That silence was a low moment. But perhaps New York hit bottom faster. Senator Skelos, the prosecutors charged, arranged to meet Long Island politicians at the wake of Wenjian Liu, a New York City police officer shot dead in December, to press for payments to the company employing his son.

Sometimes it seems as though for some people, the only thing to be ashamed of is shame itself.

Finding Scandal in New York and New Jersey, but No Shame

Mr. Tepper was not a musical child and had no formal training, but he grew up to write both lyrics and tunes, trading off duties with the other member of the team, Roy C. Bennett.

Sid Tepper Dies at 96; Delivered ‘Red Roses for a Blue Lady’ and Other Songs

At the National Institutes of Health, Dr. Suzman’s signature accomplishment was the central role he played in creating a global network of surveys on aging.

Richard Suzman, 72, Dies; Researcher Influenced Global Surveys on Aging

Mr. Haroche was a founder of Liberty Travel, which grew from a two-man operation to the largest leisure travel operation in the United States.

Gilbert Haroche, Builder of an Economy Travel Empire, Dies at 87

The career criminals in genre novels don’t have money problems. If they need some, they just go out and steal it. But such financial transactions can backfire, which is what happened back in 2004 when the Texas gang in Michael

Take the Money and Run

Judge Patterson helped to protect the rights of Attica inmates after the prison riot in 1971 and later served on the Federal District Court in Manhattan.

Robert Patterson Jr., Lawyer and Judge Who Fought for the Accused, Dies at 91

WASHINGTON — The former deputy director of the C.I.A. asserts in a forthcoming book that Republicans, in their eagerness to politicize the killing of the American ambassador to Libya, repeatedly distorted the agency’s analysis of events. But he also argues that the C.I.A. should get out of the business of providing “talking points” for administration officials in national security events that quickly become partisan, as happened after the Benghazi attack in 2012.

The official, Michael J. Morell, dismisses the allegation that the United States military and C.I.A. officers “were ordered to stand down and not come to the rescue of their comrades,” and he says there is “no evidence” to support the charge that “there was a conspiracy between C.I.A. and the White House to spin the Benghazi story in a way that would protect the political interests of the president and Secretary Clinton,” referring to the secretary of state at the time, Hillary Rodham Clinton.

But he also concludes that the White House itself embellished some of the talking points provided by the Central Intelligence Agency and had blocked him from sending an internal study of agency conclusions to Congress.

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Michael J. Morell Credit Mark Wilson/Getty Images

“I finally did so without asking,” just before leaving government, he writes, and after the White House released internal emails to a committee investigating the State Department’s handling of the issue.

A lengthy congressional investigation remains underway, one that many Republicans hope to use against Mrs. Clinton in the 2016 election cycle.

In parts of the book, “The Great War of Our Time” (Twelve), Mr. Morell praises his C.I.A. colleagues for many successes in stopping terrorist attacks, but he is surprisingly critical of other C.I.A. failings — and those of the National Security Agency.

Soon after Mr. Morell retired in 2013 after 33 years in the agency, President Obama appointed him to a commission reviewing the actions of the National Security Agency after the disclosures of Edward J. Snowden, a former intelligence contractor who released classified documents about the government’s eavesdropping abilities. Mr. Morell writes that he was surprised by what he found.

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“You would have thought that of all the government entities on the planet, the one least vulnerable to such grand theft would have been the N.S.A.,” he writes. “But it turned out that the N.S.A. had left itself vulnerable.”

He concludes that most Wall Street firms had better cybersecurity than the N.S.A. had when Mr. Snowden swept information from its systems in 2013. While he said he found himself “chagrined by how well the N.S.A. was doing” compared with the C.I.A. in stepping up its collection of data on intelligence targets, he also sensed that the N.S.A., which specializes in electronic spying, was operating without considering the implications of its methods.

“The N.S.A. had largely been collecting information because it could, not necessarily in all cases because it should,” he says.

The book is to be released next week.

Mr. Morell was a career analyst who rose through the ranks of the agency, and he ended up in the No. 2 post. He served as President George W. Bush’s personal intelligence briefer in the first months of his presidency — in those days, he could often be spotted at the Starbucks in Waco, Tex., catching up on his reading — and was with him in the schoolhouse in Florida on the morning of Sept. 11, 2001, when the Bush presidency changed in an instant.

Mr. Morell twice took over as acting C.I.A. director, first when Leon E. Panetta was appointed secretary of defense and then when retired Gen. David H. Petraeus resigned over an extramarital affair with his biographer, a relationship that included his handing her classified notes of his time as America’s best-known military commander.

Mr. Morell says he first learned of the affair from Mr. Petraeus only the night before he resigned, and just as the Benghazi events were turning into a political firestorm. While praising Mr. Petraeus, who had told his deputy “I am very lucky” to run the C.I.A., Mr. Morell writes that “the organization did not feel the same way about him.” The former general “created the impression through the tone of his voice and his body language that he did not want people to disagree with him (which was not true in my own interaction with him),” he says.

But it is his account of the Benghazi attacks — and how the C.I.A. was drawn into the debate over whether the Obama White House deliberately distorted its account of the death of Ambassador J. Christopher Stevens — that is bound to attract attention, at least partly because of its relevance to the coming presidential election. The initial assessments that the C.I.A. gave to the White House said demonstrations had preceded the attack. By the time analysts reversed their opinion, Susan E. Rice, now the national security adviser, had made a series of statements on Sunday talk shows describing the initial assessment. The controversy and other comments Ms. Rice made derailed Mr. Obama’s plan to appoint her as secretary of state.

The experience prompted Mr. Morell to write that the C.I.A. should stay out of the business of preparing talking points — especially on issues that are being seized upon for “political purposes.” He is critical of the State Department for not beefing up security in Libya for its diplomats, as the C.I.A., he said, did for its employees.

But he concludes that the assault in which the ambassador was killed took place “with little or no advance planning” and “was not well organized.” He says the attackers “did not appear to be looking for Americans to harm. They appeared intent on looting and conducting some vandalism,” setting fires that killed Mr. Stevens and a security official, Sean Smith.

Mr. Morell paints a picture of an agency that was struggling, largely unsuccessfully, to understand dynamics in the Middle East and North Africa when the Arab Spring broke out in late 2011 in Tunisia. The agency’s analysts failed to see the forces of revolution coming — and then failed again, he writes, when they told Mr. Obama that the uprisings would undercut Al Qaeda by showing there was a democratic pathway to change.

“There is no good explanation for our not being able to see the pressures growing to dangerous levels across the region,” he writes. The agency had again relied too heavily “on a handful of strong leaders in the countries of concern to help us understand what was going on in the Arab street,” he says, and those leaders themselves were clueless.

Moreover, an agency that has always overvalued secretly gathered intelligence and undervalued “open source” material “was not doing enough to mine the wealth of information available through social media,” he writes. “We thought and told policy makers that this outburst of popular revolt would damage Al Qaeda by undermining the group’s narrative,” he writes.

Instead, weak governments in Egypt, and the absence of governance from Libya to Yemen, were “a boon to Islamic extremists across both the Middle East and North Africa.”

Mr. Morell is gentle about most of the politicians he dealt with — he expresses admiration for both Mr. Bush and Mr. Obama, though he accuses former Vice President Dick Cheney of deliberately implying a connection between Al Qaeda and Iraq that the C.I.A. had concluded probably did not exist. But when it comes to the events leading up to the Bush administration’s decision to go to war in Iraq, he is critical of his own agency.

Mr. Morell concludes that the Bush White House did not have to twist intelligence on Saddam Hussein’s alleged effort to rekindle the country’s work on weapons of mass destruction.

“The view that hard-liners in the Bush administration forced the intelligence community into its position on W.M.D. is just flat wrong,” he writes. “No one pushed. The analysts were already there and they had been there for years, long before Bush came to office.”

Ex-C.I.A. Official Rebuts Republican Claims on Benghazi Attack in ‘The Great War of Our Time’

UNITED NATIONS — Wearing pinstripes and a pince-nez, Staffan de Mistura, the United Nations envoy for Syria, arrived at the Security Council one Tuesday afternoon in February and announced that President Bashar al-Assad had agreed to halt airstrikes over Aleppo. Would the rebels, Mr. de Mistura suggested, agree to halt their shelling?

What he did not announce, but everyone knew by then, was that the Assad government had begun a military offensive to encircle opposition-held enclaves in Aleppo and that fierce fighting was underway. It would take only a few days for rebel leaders, having pushed back Syrian government forces, to outright reject Mr. de Mistura’s proposed freeze in the fighting, dooming the latest diplomatic overture on Syria.

Diplomacy is often about appearing to be doing something until the time is ripe for a deal to be done.

 

 

Now, with Mr. Assad’s forces having suffered a string of losses on the battlefield and the United States reaching at least a partial rapprochement with Mr. Assad’s main backer, Iran, Mr. de Mistura is changing course. Starting Monday, he is set to hold a series of closed talks in Geneva with the warring sides and their main supporters. Iran will be among them.

In an interview at United Nations headquarters last week, Mr. de Mistura hinted that the changing circumstances, both military and diplomatic, may have prompted various backers of the war to question how much longer the bloodshed could go on.

“Will that have an impact in accelerating the willingness for a political solution? We need to test it,” he said. “The Geneva consultations may be a good umbrella for testing that. It’s an occasion for asking everyone, including the government, if there is any new way that they are looking at a political solution, as they too claim they want.”

He said he would have a better assessment at the end of June, when he expects to wrap up his consultations. That coincides with the deadline for a final agreement in the Iran nuclear talks.

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Whether a nuclear deal with Iran will pave the way for a new opening on peace talks in Syria remains to be seen. Increasingly, though, world leaders are explicitly linking the two, with the European Union’s top diplomat, Federica Mogherini, suggesting last week that a nuclear agreement could spur Tehran to play “a major but positive role in Syria.”

It could hardly come soon enough. Now in its fifth year, the Syrian war has claimed 220,000 lives, prompted an exodus of more than three million refugees and unleashed jihadist groups across the region. “This conflict is producing a question mark in many — where is it leading and whether this can be sustained,” Mr. de Mistura said.

Part Italian, part Swedish, Mr. de Mistura has worked with the United Nations for more than 40 years, but he is more widely known for his dapper style than for any diplomatic coups. Syria is by far the toughest assignment of his career — indeed, two of the organization’s most seasoned diplomats, Lakhdar Brahimi and Kofi Annan, tried to do the job and gave up — and critics have wondered aloud whether Mr. de Mistura is up to the task.

He served as a United Nations envoy in Afghanistan and Iraq, and before that in Lebanon, where a former minister recalled, with some scorn, that he spent many hours sunbathing at a private club in the hills above Beirut. Those who know him say he has a taste for fine suits and can sometimes speak too soon and too much, just as they point to his diplomatic missteps and hyperbole.

They cite, for instance, a news conference in October, when he raised the specter of Srebrenica, where thousands of Muslims were massacred in 1995 during the Balkans war, in warning that the Syrian border town of Kobani could fall to the Islamic State. In February, he was photographed at a party in Damascus, the Syrian capital, celebrating the anniversary of the Iranian revolution just as Syrian forces, aided by Iran, were pummeling rebel-held suburbs of Damascus; critics seized on that as evidence of his coziness with the government.

Mouin Rabbani, who served briefly as the head of Mr. de Mistura’s political affairs unit and has since emerged as one of his most outspoken critics, said Mr. de Mistura did not have the background necessary for the job. “This isn’t someone well known for his political vision or political imagination, and his closest confidants lack the requisite knowledge and experience,” Mr. Rabbani said.

As a deputy foreign minister in the Italian government, Mr. de Mistura was tasked in 2012 with freeing two Italian marines detained in India for shooting at Indian fishermen. He made 19 trips to India, to little effect. One marine was allowed to return to Italy for medical reasons; the other remains in India.

He said he initially turned down the Syria job when the United Nations secretary general approached him last August, only to change his mind the next day, after a sleepless, guilt-ridden night.

Mr. de Mistura compared his role in Syria to that of a doctor faced with a terminally ill patient. His goal in brokering a freeze in the fighting, he said, was to alleviate suffering. He settled on Aleppo as the location for its “fame,” he said, a decision that some questioned, considering that Aleppo was far trickier than the many other lesser-known towns where activists had negotiated temporary local cease-fires.

“Everybody, at least in Europe, are very familiar with the value of Aleppo,” Mr. de Mistura said. “So I was using that as an icebreaker.”

The cease-fire negotiations, to which he had devoted six months, fell apart quickly because of the government’s military offensive in Aleppo the very day of his announcement at the Security Council. Privately, United Nations diplomats said Mr. de Mistura had been manipulated. To this, Mr. de Mistura said only that he was “disappointed and concerned.”

Tarek Fares, a former rebel fighter, said after a recent visit to Aleppo that no Syrian would admit publicly to supporting Mr. de Mistura’s cease-fire proposal. “If anyone said they went to a de Mistura meeting in Gaziantep, they would be arrested,” is how he put it, referring to the Turkish city where negotiations between the two sides were held.

Secretary General Ban Ki-moon remains staunchly behind Mr. de Mistura’s efforts. His defenders point out that he is at the center of one of the world’s toughest diplomatic problems, charged with mediating a conflict in which two of the world’s most powerful nations — Russia, which supports Mr. Assad, and the United States, which has called for his ouster — remain deadlocked.

R. Nicholas Burns, a former State Department official who now teaches at Harvard, credited Mr. de Mistura for trying to negotiate a cease-fire even when the chances of success were exceedingly small — and the chances of a political deal even smaller. For his efforts to work, Professor Burns argued, the world powers will first have to come to an agreement of their own.

“He needs the help of outside powers,” he said. “It starts with backers of Assad. That’s Russia and Iran. De Mistura is there, waiting.”

With Iran Talks, a Tangled Path to Ending Syria’s War

Mr. Napoleon was a self-taught musician whose career began in earnest with the orchestra led by Chico Marx of the Marx Brothers.

Marty Napoleon, 93, Dies; Jazz Pianist Played With Louis Armstrong

The 2015 Met Gala has only officially begun, but there's a clear leader in the race for best couple, no small feat at an event that threatens to sap Hollywood of every celebrity it has for the duration of an East Coast evening.

That would be Marc Jacobs and his surprise guest (who, by some miracle, remained under wraps until their red carpet debut), Cher.

“This has been a dream of mine for a very, very long time,” Mr. Jacobs said.

It is Cher's first appearance at the Met Gala since 1997, when she arrived on the arm of Donatella Versace.

– MATTHEW SCHNEIER

Cher and Marc Jacobs

Since a white police officer, Darren Wilson fatally shot unarmed black teenager, Michael Brown, in a confrontation last August in Ferguson, Mo., there have been many other cases in which the police have shot and killed suspects, some of them unarmed. Mr. Brown's death set off protests throughout the country, pushing law enforcement into the spotlight and sparking a public debate on police tactics. Here is a selection of police shootings that have been reported by news organizations since Mr. Brown's death. In some cases, investigations are continuing.

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The apartment complex northeast of Atlanta where Anthony Hill, 27, was fatally shot by a DeKalb County police officer. Credit Ben Gray/Atlanta Journal Constitution

Chamblee, Ga.
Fatal Police Shootings: Accounts Since Ferguson

WASHINGTON — The last three men to win the Republican nomination have been the prosperous son of a president (George W. Bush), a senator who could not recall how many homes his family owned (John McCain of Arizona; it was seven) and a private equity executive worth an estimated $200 million (Mitt Romney).

The candidates hoping to be the party’s nominee in 2016 are trying to create a very different set of associations. On Sunday, Ben Carson, a retired neurosurgeon, joined the presidential field.

Senator Marco Rubio of Florida praises his parents, a bartender and a Kmart stock clerk, as he urges audiences not to forget “the workers in our hotel kitchens, the landscaping crews in our neighborhoods, the late-night janitorial staff that clean our offices.”

Gov. Scott Walker of Wisconsin, a preacher’s son, posts on Twitter about his ham-and-cheese sandwiches and boasts of his coupon-clipping frugality. His $1 Kohl’s sweater has become a campaign celebrity in its own right.

Senator Rand Paul of Kentucky laments the existence of “two Americas,” borrowing the Rev. Dr. Martin Luther King Jr.’s phrase to describe economically and racially troubled communities like Ferguson, Mo., and Detroit.

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Senator Marco Rubio of Florida praises his parents, a bartender and a Kmart stock clerk. Credit Joe Raedle/Getty Images

“Some say, ‘But Democrats care more about the poor,’ ” Mr. Paul likes to say. “If that’s true, why is black unemployment still twice white unemployment? Why has household income declined by $3,500 over the past six years?”

We are in the midst of the Empathy Primary — the rhetorical battleground shaping the Republican presidential field of 2016.

Harmed by the perception that they favor the wealthy at the expense of middle-of-the-road Americans, the party’s contenders are each trying their hardest to get across what the elder George Bush once inelegantly told recession-battered voters in 1992: “Message: I care.”

Their ability to do so — less bluntly, more sincerely — could prove decisive in an election year when power, privilege and family connections will loom large for both parties.

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Questions of understanding and compassion cost Republicans in the last election. Mr. Romney, who memorably dismissed the “47 percent” of Americans as freeloaders, lost to President Obama by 63 percentage points among voters who cast their ballots for the candidate who “cares about people like me,” according to exit polls.

And a Pew poll from February showed that people still believe Republicans are indifferent to working Americans: 54 percent said the Republican Party does not care about the middle class.

That taint of callousness explains why Senator Ted Cruz of Texas declared last week that Republicans “are and should be the party of the 47 percent” — and why another son of a president, Jeb Bush, has made economic opportunity the centerpiece of his message.

With his pedigree and considerable wealth — since he left the Florida governor’s office almost a decade ago he has earned millions of dollars sitting on corporate boards and advising banks — Mr. Bush probably has the most complicated task making the argument to voters that he understands their concerns.

On a visit last week to Puerto Rico, Mr. Bush sounded every bit the populist, railing against “elites” who have stifled economic growth and innovation. In the kind of economy he envisions leading, he said: “We wouldn’t have the middle being squeezed. People in poverty would have a chance to rise up. And the social strains that exist — because the haves and have-nots is the big debate in our country today — would subside.”

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Who Is Running for President (and Who’s Not)?

Republicans’ emphasis on poorer and working-class Americans now represents a shift from the party’s longstanding focus on business owners and “job creators” as the drivers of economic opportunity.

This is intentional, Republican operatives said.

In the last presidential election, Republicans rushed to defend business owners against what they saw as hostility by Democrats to successful, wealthy entrepreneurs.

“Part of what you had was a reaction to the Democrats’ dehumanization of business owners: ‘Oh, you think you started your plumbing company? No you didn’t,’ ” said Grover Norquist, the conservative activist and president of Americans for Tax Reform.

But now, Mr. Norquist said, Republicans should move past that. “Focus on the people in the room who know someone who couldn’t get a job, or a promotion, or a raise because taxes are too high or regulations eat up companies’ time,” he said. “The rich guy can take care of himself.”

Democrats argue that the public will ultimately see through such an approach because Republican positions like opposing a minimum-wage increase and giving private banks a larger role in student loans would hurt working Americans.

“If Republican candidates are just repeating the same tired policies, I’m not sure that smiling while saying it is going to be enough,” said Guy Cecil, a Democratic strategist who is joining a “super PAC” working on behalf of Hillary Rodham Clinton.

Republicans have already attacked Mrs. Clinton over the wealth and power she and her husband have accumulated, caricaturing her as an out-of-touch multimillionaire who earns hundreds of thousands of dollars per speech and has not driven a car since 1996.

Mr. Walker hit this theme recently on Fox News, pointing to Mrs. Clinton’s lucrative book deals and her multiple residences. “This is not someone who is connected with everyday Americans,” he said. His own net worth, according to The Milwaukee Journal Sentinel, is less than a half-million dollars; Mr. Walker also owes tens of thousands of dollars on his credit cards.

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But showing off a cheap sweater or boasting of a bootstraps family background not only helps draw a contrast with Mrs. Clinton’s latter-day affluence, it is also an implicit argument against Mr. Bush.

Mr. Walker, who featured a 1998 Saturn with more than 100,000 miles on the odometer in a 2010 campaign ad during his first run for governor, likes to talk about flipping burgers at McDonald’s as a young person. His mother, he has said, grew up on a farm with no indoor plumbing until she was in high school.

Mr. Rubio, among the least wealthy members of the Senate, with an estimated net worth of around a half-million dollars, uses his working-class upbringing as evidence of the “exceptionalism” of America, “where even the son of a bartender and a maid can have the same dreams and the same future as those who come from power and privilege.”

Mr. Cruz alludes to his family’s dysfunction — his parents, he says, were heavy drinkers — and recounts his father’s tale of fleeing Cuba with $100 sewn into his underwear.

Gov. Chris Christie of New Jersey notes that his father paid his way through college working nights at an ice cream plant.

But sometimes the attempts at projecting authenticity can seem forced. Mr. Christie recently found himself on the defensive after telling a New Hampshire audience, “I don’t consider myself a wealthy man.” Tax returns showed that he and his wife, a longtime Wall Street executive, earned nearly $700,000 in 2013.

The story of success against the odds is a political classic, even if it is one the Republican Party has not been able to tell for a long time. Ronald Reagan liked to say that while he had not been born on the wrong side of the tracks, he could always hear the whistle. Richard Nixon was fond of reminding voters how he was born in a house his father had built.

“Probably the idea that is most attractive to an average voter, and an idea that both Republicans and Democrats try to craft into their messages, is this idea that you can rise from nothing,” said Charles C. W. Cooke, a writer for National Review.

There is a certain delight Republicans take in turning that message to their advantage now.

“That’s what Obama did with Hillary,” Mr. Cooke said. “He acknowledged it openly: ‘This is ridiculous. Look at me, this one-term senator with dark skin and all of America’s unsolved racial problems, running against the wife of the last Democratic president.”

G.O.P. Hopefuls Now Aiming to Woo the Middle Class

A former member of the Boston Symphony Orchestra, Mr. Smedvig helped found the wide-ranging Empire Brass quintet.

Rolf Smedvig, Trumpeter in the Empire Brass, Dies at 62
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harga berangkat umrah juni di Pasar Rebo jakarta
promo berangkat umroh januari di Cibubur jakarta
biaya paket umrah desember di Kramat Jati jakarta
paket promo umroh maret di Cipinang Cempedak jakarta
paket promo umrah april di Susukan jakarta
promo berangkat umroh maret di Bambu Apus jakarta
paket promo umroh april di Kampung Melayu jakarta
paket promo umroh desember di Ciracas jakarta
biaya paket berangkat umrah januari di Pal Meriam jakarta
paket berangkat umrah mei di Setu jakarta
paket umrah desember di Cipinang Besar Utara jakarta
biaya paket berangkat umroh april di Rawamangun jakarta
harga paket berangkat umroh juni di Kramat Jati jakarta
promo umroh april di Cilangkap jakarta
biaya paket berangkat umroh akhir tahun di Batuampar jakarta
paket berangkat umrah juni di Bidaracina jakarta
biaya berangkat umroh mei di Utan Kayu Selatan jakarta
paket berangkat umroh akhir tahun di Duren Sawit jakarta
biaya berangkat umroh ramadhan di Pinang Ranti jakarta
biaya berangkat umroh maret di Pal Meriam jakarta
paket berangkat umrah maret di Pulogebang jakarta
biaya berangkat umrah januari di Cibubur jakarta
biaya umrah desember di Pasar Rebo jakarta
paket umroh juni di Kayu Putih jakarta
harga paket umrah awal tahun di Cakung jakarta
paket promo berangkat umroh februari di Pondok Bambu jakarta
paket umrah april di Pulo Gadung jakarta
biaya umrah maret di Rawa Bunga jakarta
biaya paket umrah januari di Utan Kayu Selatan jakarta
paket umroh ramadhan depok
harga paket umroh januari di Jatinegara jakarta
harga berangkat umroh desember di Utan Kayu Selatan jakarta
biaya berangkat umroh februari di Kampung Gedong,Cijantung jakarta
paket promo umrah juni di Halim Perdanakusuma jakarta