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Randomized double-blind comparison of ketamine-propofol, fentanyl-propofol and propofol-saline on haemodynamics and laryngeal mask airway insertion conditions

Goh PK, Chiu CL, Wang CY, Chan YK, Loo PL

Anaesth Intensive Care, 2005 Apr;33(2):223-8.
PMID: 15960405

The aim of this prospective, double-blind, randomized, placebo-controlled clinical trial was to investigate whether the administration of ketamine before induction with propofol improves its associated haemodynamic profile and laryngeal mask airway (LMA) insertion conditions. Ninety adult patients were randomly allocated to receive either ketamine 0.5 mg x kg(-1) (n = 30), fentanyl 1 microg x kg(-1) (n = 30) or normal saline (n = 30), before induction of anaesthesia with propofol 2.5 mg x kg(-1). Insertion of the LMA was performed 60s after injection of propofol. Arterial blood pressure and heart rate were measured before induction (baseline), immediately after induction, immediately before LMA insertion, immediately after LMA insertion and every minute for three minutes after LMA insertion. Following LMA insertion, the following six subjective endpoints were graded by a blinded anaesthestist using ordinal scales graded 1 to 3: mouth opening, gagging, swallowing, movement, laryngospasm and ease of insertion. Systolic blood pressure was significantly higher following ketamine than either fentanyl (P = 0.010) or saline (P = 0.0001). The median (interquartile range) summed score describing the overall insertion conditions were similar in the ketamine [median 7.0, interquartile range (6.0-8.0)] and fentanyl groups [median 7.0, interquartile range (6.0-8.0)]. Both appeared significantly better than the saline group [median 8.0, interquartile range (6.75-9.25); P = 0.024]. The incidence of prolonged apnoea (> 120s) was higher in the fentanyl group [23.1% (7/30)] compared with the ketamine [6.3% (2/30)] and saline groups [3.3% (1/30)]. We conclude that the addition of ketamine 0.5 mg x kg(-1) improves haemodynamics when compared to fentanyl 1 microg x kg(-1), with less prolonged apnoea, and is associated with better LMA insertion conditions than placebo (saline).
Bispectral index during modified rapid sequence induction using thiopentone or propofol and rocuronium

Sie MY, Goh PK, Chan L, Ong SY

Anaesth Intensive Care, 2004 Feb;32(1):28-30.
PMID: 15058117

This randomized controlled trial compared Bispectral Index (BIS) values in 40 patients after a modified rapid sequence induction using thiopentone 4 mg/kg or propofol 2 mg/kg with rocuronium 0.6 mg/kg as muscle relaxant. Endotracheal intubation was performed at 60 seconds from induction of anaesthesia and BIS values were recorded for three minutes after induction. At the 120, 150 and 180 second measurements there was a significantly greater proportion of subjects with BIS values < or = 60 ("anaesthetized") in the propofol group compared with the thiopentone group (P values < 0.02, < 0.01 and < 0.01 respectively). All intubations were completed within two minutes. No explicit recall of intubation was detected clinically with either induction agent. The BIS scores we have measured suggest that thiopentone 4 mg/kg is more likely to be associated with lighter planes of anaesthesia and consequent risk of awareness than propofol 2 mg/kg, if intubation is delayed or prolonged.
Novel synergistic hydrous iron-nickel-manganese (HINM) trimetal oxide for hazardous arsenite removal

Nasir AM, Goh PS, Ismail AF

Chemosphere, 2018 Jun;200:504-512.
PMID: 29501887 DOI: 10.1016/j.chemosphere.2018.02.126

A novel hydrous iron-nickel-manganese (HINM) trimetal oxide was successfully fabricated using oxidation and coprecipitation method for metalloid arsenite removal. The atomic ratio of Fe:Ni:Mn for this adsorbent is 3:2:1. HINM adsorbent was identified as an amorphous nanosized adsorbent with particle size ranged from 30 nm to 60 nm meanwhile the total active surface area and pore diameter of HINM area of 195.78 m2/g and 2.43 nm, respectively. Experimental data of arsenite adsorption is best fitted into pseudo-second order and Freundlich isotherm model. The maximum adsorption capacity of arsenite onto HINM was 81.9 mg/g. Thermodynamic study showed that the adsorption of arsenite was a spontaneous and endothermic reaction with enthalpy change of 14.04 kJ/mol and Gibbs energy of -12 to -14 kJ/mol. Zeta potential, thermal gravimetric (TGA) and Fourier transform infrared (FTIR) analysis were applied to elucidate the mechanism of arsenite adsorption by HINM. Mechanism of arsenite adsorption by HINM involved both chemisorption and physisorption based on the electrostatic attraction between arsenite ions and surface charge of HINM. It also involved the hydroxyl substitution by arsenite ions through the formation of inner-sphere complex. Reusability of HINM trimetal oxide was up to 89% after three cycles of testing implied that HINM trimetal oxide is a promising and practical adsorbent for arsenite.
Electrochemical quantification of atrazine-fulvic acid and removal through bismuth tungstate photocatalytic hybrid membranes

Krishnan SAG, Gumpu MB, Arthanareeswaran G, Goh PS, Aziz F, Ismail AF

Chemosphere, 2023 Jan;311(Pt 2):137016.
PMID: 36374783 DOI: 10.1016/j.chemosphere.2022.137016

Herbicides such as atrazine and humus substances such as fulvic acid are widely used in agricultural sector. They can be traced in surface and groundwater around the agriculture field at concentrations beyond the approved limit due to their mobility and persistence. Bismuth-based photocatalysts activated by visible light are potential materials for removing various organic pollutants from water bodies. These photocatalysts can also be suitable candidates for developing a hybrid membrane with anti-fouling properties. In this study, Bi2WO6 nanoparticles were synthesized via the hydrothermal method and integrated into the cellulose acetate (CA), polyetherimide (PEI), polysulfone (PSF) and polyvinylidene fluoride (PVDF) polymers via physical blending approach. The hybrid membranes were then characterized by FTIR, XPS and FESEM to confirm the chemical bonding, chemical composition and surface morphology of Bi2WO6. Thus, the pure water flux of CA (35.6 L m-2 h-1), PEI (46.56 L m-2 h-1), PSF (6.84 L m-2 h-1), and PVDF (68.47 L m-2 h-1) hybrid membranes has significantly enhanced than the pristine CA, PEI, PSF and PVDF membranes. The significant rejection of atrazine-fulvic acid was observed with hybrid membranes in the order of CA (84.1%) > PVDF (72.7%) > PEI (47.8%) > PSF (37.2%), and these membranes have shown an excellent flux recovery ratio than pristine membranes. Further, electrochemical quantification studies were performed to analyze the removal efficiency of atrazine-fulvic acid from water. In this present work, GO-modified SPE was employed for electrochemical sensing studies. The resultant CA hybrid membrane achieved removal efficiency of 84.08% for atrazine. It was observed that the Bi2WO6 established strong bonding with CA, and PVDF membranes, thus showing a significant removal efficiency and FRR than other hybrid and pristine membranes.
Facile synthesis of GO and g-C3N4 nanosheets encapsulated magnetite ternary nanocomposite for superior photocatalytic degradation of phenol

Rehman GU, Tahir M, Goh PS, Ismail AF, Samavati A, Zulhairun AK, et al.

Environ Pollut, 2019 Oct;253:1066-1078.
PMID: 31434184 DOI: 10.1016/j.envpol.2019.07.013

In this study, the synthesis of Fe3O4@GO@g-C3N4 ternary nanocomposite for enhanced photocatalytic degradation of phenol has been investigated. The surface modification of Fe3O4 was performed through layer-by-layer electrostatic deposition meanwhile the heterojunction structure of ternary nanocomposite was obtained through sonicated assisted hydrothermal method. The photocatalysts were characterized for their crystallinity, surface morphology, chemical functionalities, and band gap energy. The Fe3O4@GO@g-C3N4 ternary nanocomposite achieved phenol degradation of ∼97%, which was significantly higher than that of Fe3O4@GO (∼75%) and Fe3O4 (∼62%). The enhanced photoactivity was due to the efficient charge carrier separation and desired band structure. The photocatalytic performance was further enhanced with the addition of hydrogen peroxide, in which phenol degradation up to 100% was achieved in 2 h irradiation time. The findings revealed that operating parameters have significant influences on the photocatalytic activities. It was found that lower phenol concentration promoted higher activity. In this study, 0.3 g of Fe3O4@GO@g-C3N4 was found to be the optimized photocatalyst for phenol degradation. At the optimized condition, the reaction rate constant was reported as 6.96 × 10-3 min-1. The ternary photocatalyst showed excellent recyclability in three consecutive cycles, which confirmed the stability of this ternary nanocomposite for degradation applications.
Fulltext COVID-19: Four Paediatric Cases in Malaysia

See KC, Liew SM, Ng DCE, Chew EL, Khoo EM, Sam CH, et al.

Int J Infect Dis, 2020 May;94:125-127.
PMID: 32304822 DOI: 10.1016/j.ijid.2020.03.049

OBJECTIVE: This is a brief report of 4 paediatric cases of COVID-19 infection in Malaysia BACKGROUND: COVID-19, a coronavirus, first detected in Wuhan, China has now spread rapidly to over 60 countries and territories around the world, infecting more than 85000 individuals. As the case count amongst children is low, there is need to report COVID-19 in children to better understand the virus and the disease.
CASES: In Malaysia, until end of February 2020, there were four COVID-19 paediatric cases with ages ranging from 20 months to 11 years. All four cases were likely to have contracted the virus in China. The children had no symptoms or mild flu-like illness. The cases were managed symptomatically. None required antiviral therapy.
DISCUSSION: There were 2 major issues regarding the care of infected children. Firstly, the quarantine of an infected child with a parent who tested negative was an ethical dilemma. Secondly, oropharyngeal and nasal swabs in children were at risk of false negative results. These issues have implications for infection control. Consequently, there is a need for clearer guidelines for child quarantine and testing methods in the management of COVID-19 in children.
Pre-treatment of multi-walled carbon nanotubes for polyetherimide mixed matrix hollow fiber membranes

Goh PS, Ng BC, Ismail AF, Aziz M, Hayashi Y

J Colloid Interface Sci, 2012 Nov 15;386(1):80-7.
PMID: 22909959 DOI: 10.1016/j.jcis.2012.07.033

Mixed matrix hollow fibers composed of multi-walled carbon nanotubes (MWCNTs) and polyetherimide (PEI) were fabricated. Pre-treatment of MWCNTs was carried out prior to the incorporation into the polymer matrix using a simple and feasible two stages approach that involved dry air oxidation and surfactant dispersion. The characterizations of the surface treated MWCNTs using TEM and Raman spectroscopy have evidenced the effectiveness of dry air oxidation in eliminating undesired amorphous carbon and metal catalyst while surfactant dispersion using Triton X100 has suppressed the agglomeration of MWCNTs. The resultant mixed matrix hollow fibers were applied for O(2)/N(2) pure gas separation. Interestingly, it was found that removal of disordered amorphous carbons and metal particles has allowed the hollow structures to be more accessible for the fast and smooth transport of gas molecules, hence resulted in noticeable improvement in the gas separation properties. The composite hollow fibers embedded with the surface modified MWCNTs showed increase in permeability as much as 60% while maintaining the selectivity of the O(2)/N(2) gas pair. This study highlights the necessity to establish an appropriate pre-treatment approach for MWCNTs in order to fully utilize the beneficial transport properties of this material in mixed matrix polymer nanocomposite for gas separation.
How should front-line general practitioners use personal protective equipment (PPE)?

Ambigapathy S, Rajahram GS, Shamsudin UK, Khoo EM, Cheah WK, Peariasamy KM, et al.

Malays Fam Physician, 2020;15(1):2-5.
PMID: 32284798

The COVID-19 outbreak continues to evolve with the number of cases increasing in Malaysia, placing a significant burden on general practitioners (GPs) to assess and manage suspected cases. GPs must be well equipped with knowledge to set up their clinics, use Personal Protective Equipment (PPE) appropriately, adopt standard protocols on triaging and referrals, as well as educate patients about PPE. The correct use of PPE will help GPs balance between personal safety and appropriate levels of public concern.
Fulltext Flex Sensor Compensator via Hammerstein-Wiener Modeling Approach for Improved Dynamic Goniometry and Constrained Control of a Bionic Hand

Syed Mubarak Ali SAA, Ahmad NS, Goh P

Sensors (Basel), 2019 Sep 10;19(18).
PMID: 31509987 DOI: 10.3390/s19183896

In this paper, a new control-centric approach is introduced to model the characteristics of flex sensors on a goniometric glove, which is designed to capture the user hand gesture that can be used to wirelessly control a bionic hand. The main technique employs the inverse dynamic model strategy along with a black-box identification for the compensator design, which is aimed to provide an approximate linear mapping between the raw sensor output and the dynamic finger goniometry. To smoothly recover the goniometry on the bionic hand's side during the wireless transmission, the compensator is restructured into a Hammerstein-Wiener model, which consists of a linear dynamic system and two static nonlinearities. A series of real-time experiments involving several hand gestures have been conducted to analyze the performance of the proposed method. The associated temporal and spatial gesture data from both the glove and the bionic hand are recorded, and the performance is evaluated in terms of the integral of absolute error between the glove's and the bionic hand's dynamic goniometry. The proposed method is also compared with the raw sensor data, which has been preliminarily calibrated with the finger goniometry, and the Wiener model, which is based on the initial inverse dynamic design strategy. Experimental results with several trials for each gesture show that a great improvement is obtained via the Hammerstein-Wiener compensator approach where the resulting average errors are significantly smaller than the other two methods. This concludes that the proposed strategy can remarkably improve the dynamic goniometry of the glove, and thus provides a smooth human-robot collaboration with the bionic hand.
Fulltext Self-Adaptive Filtering Approach for Improved Indoor Localization of a Mobile Node with Zigbee-Based RSSI and Odometry

Loganathan A, Ahmad NS, Goh P

Sensors (Basel), 2019 Nov 01;19(21).
PMID: 31683837 DOI: 10.3390/s19214748

This study presents a new technique to improve the indoor localization of a mobile node by utilizing a Zigbee-based received-signal-strength indicator (RSSI) and odometry. As both methods suffer from their own limitations, this work contributes to a novel methodological framework in which coordinates of the mobile node can more accurately be predicted by improving the path-loss propagation model and optimizing the weighting parameter for each localization technique via a convex search. A self-adaptive filtering approach is also proposed which autonomously optimizes the weighting parameter during the target node's translational and rotational motions, thus resulting in an efficient localization scheme with less computational effort. Several real-time experiments consisting of four different trajectories with different number of straight paths and curves were carried out to validate the proposed methods. Both temporal and spatial analyses demonstrate that when odometry data and RSSI values are available, the proposed methods provide significant improvements on localization performance over existing approaches.
Fulltext Diabetic eye screening in Malaysia: findings from the National Health and Morbidity Survey 2006

Goh PP, Omar MA, Yusoff AF

Singapore Med J, 2010 Aug;51(8):631-4.
PMID: 20848059

INTRODUCTION: Diabetic retinopathy (DR) is the commonest complication of diabetes mellitus (DM), and is the leading cause of blindness among working adults. Modification of the associated risk factors as well as early detection and treatment of sight-threatening DR can prevent blindness. Clinical practice guidelines recommend annual eye screening for patients with DM. The proportion of patients in Malaysia who adhere to this recommendation was initially unknown.
METHODS: The Malaysian National Health and Morbidity Survey is a population-based survey conducted once every decade on the various aspects of health, behaviour and diseases. The DM questionnaire on eye screening was administered as face-to-face interviews with 2,373 patients with known DM who were aged 18 years and older.
RESULTS: In all, 55 percent of patients with known DM had never undergone an eye examination. Among patients who had undergone eye examinations, 32.8 percent had the last examination within the last one year, 49.8 percent within the last one to two years, and 17.4 percent more than two years ago. A significantly lower proportion of younger patients and patients who received treatment for DM from non-government facilities had previously undergone eye examinations.
CONCLUSION: The prevalence of DM observed among Malaysians aged 30 and above is 14.9 percent; thus, there is a significant number of people with potential blinding DR. Adherence to eye screening guidelines and the prompt referral of sight-threatening DR are essential in order to reduce the incidence of blindness among patients with DM.
Study name: National Health and Morbidity Survey (NHMS-2006)
Prevalence of blindness and low vision in Malaysian population: results from the National Eye Survey 1996

Zainal M, Ismail SM, Ropilah AR, Elias H, Arumugam G, Alias D, et al.

Br J Ophthalmol, 2002 Sep;86(9):951-6.
PMID: 12185113

BACKGROUND: A national eye survey was conducted in 1996 to determine the prevalence of blindness and low vision and their major causes among the Malaysian population of all ages.
METHODS: A stratified two stage cluster sampling design was used to randomly select primary and secondary sampling units. Interviews, visual acuity tests, and eye examinations on all individuals in the sampled households were performed. Estimates were weighted by factors adjusting for selection probability, non-response, and sampling coverage.
RESULTS: The overall response rate was 69% (that is, living quarters response rate was 72.8% and household response rate was 95.1%). The age adjusted prevalence of bilateral blindness and low vision was 0.29% (95% CI 0.19 to 0.39%), and 2.44% (95% CI 2.18 to 2.69%) respectively. Females had a higher age adjusted prevalence of low vision compared to males. There was no significant difference in the prevalence of bilateral low vision and blindness among the four ethnic groups, and urban and rural residents. Cataract was the leading cause of blindness (39%) followed by retinal diseases (24%). Uncorrected refractive errors (48%) and cataract (36%) were the major causes of low vision.
CONCLUSION: Malaysia has blindness and visual impairment rates that are comparable with other countries in the South East Asia region. However, cataract and uncorrected refractive errors, though readily treatable, are still the leading causes of blindness, suggesting the need for an evaluation on accessibility and availability of eye care services and barriers to eye care utilisation in the country.
Ethnicity-specific prevalences of refractive errors vary in Asian children in neighbouring Malaysia and Singapore

Saw SM, Goh PP, Cheng A, Shankar A, Tan DT, Ellwein LB

Br J Ophthalmol, 2006 Oct;90(10):1230-5.
PMID: 16809384

To compare the prevalences of refractive errors in Malay, Chinese and Indian children in Malaysia and Singapore.
Fulltext Introducing a collection of reviews on major diseases in Malaysia

Lim KG, Lim AW, Goh PP

Med J Malaysia, 2014 Aug;69 Suppl A:1-3.
PMID: 25417945

No abstract available.
Fulltext Community-based cardiovascular Risk Factors Intervention Strategies (CORFIS) in managing hypertension: A pragmatic non-randomised controlled trial

Low WHH, Seet W, Ramli AS, Ng KK, Jamaiyah H, Dan SP, et al.

Med J Malaysia, 2013 Apr;68(2):129-35.
PMID: 23629558 MyJurnal

BACKGROUND: Hypertension is the number one cardiovascular risk factor in Malaysia. This study aimed to evaluate the effectiveness of a Community-Based Cardiovascular Risk Factors Intervention Strategies (CORFIS) in the management of hypertension in primary care.
METHODS: This is a pragmatic, non-randomized controlled trial. Seventy general practitioners (GPs) were selected to provide either CORFIS (44 GPs) or conventional care (26 GPs) for 6 months. A total of 486 hypertensive patients were recruited; 309 were in the intervention and 177 in the control groups. Primary outcome was the proportion of hypertensive patients who achieved target blood pressure (BP) of <140/90mmHg (for those without diabetes mellitus) and <130/80mmHg (with diabetes mellitus). Secondary outcomes include change in the mean/median BP at 6-month as compared to baseline.
RESULTS: The proportion of hypertensive patients who achieved target BP at 6-month was significantly higher in the CORFIS arm (69.6%) as compared to the control arm (57.6%), P=0.008. Amongst those who had uncontrolled BP at baseline, the proportion who achieved target BP at 6-month was also significantly higher in the CORFIS arm (56.6%) as compared to the control arm (34.1%), p<0.001. There was no difference in the patients who had already achieved BP control at baseline. There were significant reductions in SBP in the CORFIS arm (median -9.0mmHg; -60 to 50) versus control (median -2mmHg; -50 to 48), p=0.003; as well as in DBP (CORFIS arm: median -6.0mmHg; ranged from -53 to 30 versus control arm: median 0.0mmHg; ranged from -42 to 30), p<0.001.
CONCLUSIONS: Patients who received CORFIS care demonstrated significant improvements in achieving target BP.
Fulltext Ocular biometric measurements in emmetropic and myopic Malaysian children - a population-based study

Goh PP, Azura R

Med J Malaysia, 2012 Oct;67(5):497-502.
PMID: 23770867 MyJurnal

This is the first population based study on ocular biometric measurements (OBMs) conducted in Malaysia. Its objective is to measure and compare among children of different ethnicity who have myopia and emmetropia. Subsets of children aged between 7 and 8 years old who participated in a larger population based refractive error study had their axial length, anterior chamber depth, lens thickness and vitreous depth measured using A scan and vertical and horizontal corneal curvature measured using an autokeratorefractometer. Eighty eight of the 870 children (10.1%) examined had myopia. Boys, Chinese and children with myopia had significantly longer axial length and vitreous depth compared to girls, Malay and Indian and children who were emmetropic respectively. Girls and children with myopia had steeper corneal curvature. The baseline OBMs in Malaysian children of different ethnicity are valuable for studies in myopia progression. Like other studies, children with myopia have longer axial length (P <0.001). and vitreous depth (P <0.001) compared to children who are emmetropia (without myopia).
Fulltext Diabetic retinopathy in native and non-native Sarawakians--findings from the Diabetic Eye Registry

Mallika PS, Aziz S, Goh PP, Lee PY, Cheah WL, Chong MS, et al.

Med J Malaysia, 2012 Aug;67(4):369-74.
PMID: 23082443

This study aims to determine the risk factors associated with diabetic retinopathy (DR) among natives and non-natives Sarawakians who were seen at 3 public hospitals and one health clinic in Sarawak. It is a cross sectional study where data on patients with DM were collected by staff at these healthcare facilities and entered into the web-based Diabetic Eye Registry. Univariate and multivariate analysis was used to determine the association factors for DR. DR was significantly less associated with natives (24.4%) compared to non-native Sarawakians (34.1%) (p < 0.001). The odds of getting DR was higher in patients whose duration of DM was more than 20 years (OR = 2.6), who have renal impairment (OR = 1.7) and non-natives (OR = 1.4).
Fulltext Investigator-initiated clinical trials in Malaysia and the role of the Clinical Research Centre of the Ministry of Health

Sivanandam AF, Hon YK, Yuen S, Muninathan P, Goh PP, Lim TO

Med J Malaysia, 2010 Jun;65 Suppl A:138-42.
PMID: 21488475

The objective of this review is to better understand the concept of investigator-initiated trials and its benefits. While investigator-initiated trials can be an invaluable tool, there are several challenges in its initiation and management. However, it is for these reasons that Clinical Research Centre (CRC) had developed the Investigator Initiated Trial (IIT) Programme where financial support and technical assistance are provided to local investigators embarking on their own clinical trials. In the course of preparing the review, we found that the inclination of investigator-initiated trials has yet to be well established in Ministry of Health, Malaysia. Given the potential and impact of such trials, clinicians should be aware of their ability as well as the availability of a supportive network in mobilising their concerted research efforts. Greater research collaboration among investigators could foster more innovative, insightful and constructive research.
Fulltext Retinoblastoma Registry report--Hospital Kuala Lumpur experience

Jamalia R, Sunder R, Alagaratnam J, Goh PP

Med J Malaysia, 2010 Jun;65 Suppl A:128-30.
PMID: 21488473

Retinoblastoma is a childhood ocular cancer. The aim of this paper is to describe the clinical and epidemiological characteristics of patients with retinoblastoma in a major paediatric ophthalmology center in the country. Retrospective information was collected through the retinoblastoma registry. Late presentation with advanced staging is a major problem.
Fulltext The National Medical Research Register--a vital link between current and future research

Lim TO, Asmaliza SI, Goh PP, Michael AJ, Hon YK, Thandapani R, et al.

Med J Malaysia, 2010 Jun;65 Suppl A:124-7.
PMID: 21488472

Registration of research proposal to a publicly accessible website with searchable function allows information sharing and ensures research transparency. The National Institutes of Health Malaysia, realising the importance of research registration, established the National Medical Research Register (NMRR) in 2007. The NMRR functions more than just a local register: it also links to ethics approval and MOH medical research grant application. It thus facilitates researchers in their application to the Ministry of Health Research and Ethics Committee (MREC) and for Ministry of Health research grant. In addition, MREC committee members can review research protocol on NMRR website, thus saving much time and resources. From May 2007 till December 2009, more than 3000 people have registered as NMRR public users and more than 1000 research proposals have been uploaded in NMRR. The number of registration of research proposals, clinical trials and industrial sponsored trials steadily increased from year 2007 to year 2009. The web-based NMRR is the first research register in the world that links research proposal registration to ethical review and research grant application. Its future plan is to be linked with publication. Therefore, it is indeed an innovation that Malaysians should be proud of.

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