Associate Professor Nor'azim Mohd Yunos

Associate Professor (Practice)

Jeffrey Cheah School of Medicine & Health Sciences

Email: nor.azim@monash.edu
Tel: +607 219 0600 ext:640
Office: Clinical School, JB

ORCID ID: https://orcid.org/0000-0002-5890-4825

Profile Summary

Dr Nor'azim Mohd Yunos is Associate Professor (Practice) in Intensive Care and Deputy Head (Research) of the Clinical School Johor Bahru. He is also Academic Coordinator of the Bachelor of Medical Science (Honours) program.

Dr Nor’azim is an intensivist with research interests in fluids, electrolytes and acid-base in the critically ill; and has highly cited publications in these areas. He has also been active in Evidence-Based Medicine (EBM) teaching, with regular involvement as a facilitator in local and regional EBM workshops. Another area of involvement in Patient Safety, where he is part of a Monash team that promotes Patient Safety to medical undergraduates and junior doctors.

Academic Qualifications & Professional Affiliations

  • MBBS (Malaya) 1994
  • Master of Anaesthesiology (Malaya) 2001
  • European Diploma in Intensive Care (EDIC) 2004
  • Member, Academy of Medicine (AM) 2006
  • National Specialist Register (Intensive Care) 2009
  • Graduate Certificate in Higher Education (Monash) 2014
  • PhD (Monash) 2017 (Mollie Holman Award for the best thesis in the Faculty of Medicine, Nursing and Health Sciences, Monash University).
  • Fellow of Academy of Medicine (FAMM) 2019

Current Appointments

  • Associate Professor (Practice) and Deputy Head Clinical School Johor Bahru (Research), Jeffrey Cheah School of Medicine & Health Sciences, Monash University Malaysia.
  • Sessional Intensivist, Hospital Sultanah Aminah Johor Bahru.
  • Visiting Intensivist, Gleneagles Medini, Iskandar Puteri, Johor.

Previous Appointments

  • Senior Lecturer, Jeffrey Cheah School of Medicine & Health Sciences, Monash University Malaysia. July 2007 – October 2015
  • Clinical Research Fellow, Department of Intensive Care, Austin Hospital, Victoria, Australia. February 2009 – January 2011
  • Senior Lecturer, Anaesthesiology & Intensive Care, University of Malaya Medical Centre, Kuala Lumpur. April 2005 – June 2006
  • Lecturer, Anaesthesiology & Intensive Care, University of Malaya Medical Centre, Kuala Lumpur. February 2003 – April 2005
  • Registrar, Intensive Care, The Alfred Hospital, Victoria, Australia. February 2002- January 2003
  • Lecturer, Anaesthesiology & Intensive Care, University of Malaya Medical Centre. July 2001- January 2002
  • Medical Officer/Post-graduate Trainee, Anaesthesiology & Intensive Care, University of Malaya Medical Centre, July 1997- June 2001
  • Medical Officer, Anaesthesiology & Intensive Care, Penang Hospital, Penang, Malaysia. August 1995- June 1997
  • House Officer, Sultanah Aminah Hospital, Johor, Malaysia. Medicine, Surgery, Obstetrics and Gynaecology. August 1994- July 1995
  • House Officer, Sultanah Aminah Hospital, Johor, Malaysia. Medicine, Surgery, Obstetrics and Gynaecology. August 1994- July 1995

Research & Education

Areas of interest

  • Intravenous fluids and biochemical homeostasis in the critically ill
  • Sepsis in the tropics, including dengue and multi-drug resistant infections
  • Patient Safety

Keywords: chloride, saline, acute kidney injury, intensive care

Current Research Activities

Deputy Head (Research), Clinical School Johor Bahru

Deputy Director, Tropical Medicine & Biology (TMB) Multidisciplinary Platform, Monash University Malaysia

Lead, Malaysian Society of Intensive Care Clinical Trials Group (MSIC CTG)


Principal Investigator
A Passive Surveillance of Dengue and Dengue-Like Illnesses in a Community Clinic in Johor Bahru Malaysia – extended study (under Southeast Asia Biosurveillance & Epidemiology Research SABER program) Sponsor: United States Naval Medical Research Unit 2 (NAMRU 2)
Research Contract N6264518D5058 (Mar-Sep 2019)
Amount awarded: USD 102,540 (about RM 420,000)

Co-Investigator
A Prospective Study to Evaluate Pathogenic Mechanisms of Severe Disease in Adult Dengue in Malaysia
Sponsor: Monash University Malaysia Tropical Medicine & Biology Seed Fund (a collaboration with Lee Kong Chian School of Medicine, Nanyang Technological University Singapore).
Awarded Aug 2018. Amount RM 8,000

Co-Investigator
Comparison of an isotonic balanced fluid, Sterofundin®, with 0.9% saline in traumatic brain injury (TBI): Prospective single-centre double-blind randomized controlled trial.
Principal Investigator: Khadijah Poh Yuen Yoong (University of Malaya)
ClinicalTrials.gov Identifier: NCT02866604 
Sponsor: University of Malaya - BKP Grant BK059-2017.Amount: RM 31,000

Previous Research Projects

Principal Investigator
A Passive Surveillance of Dengue and Dengue-Like Illnesses in a Community Clinic in Johor Bahru Malaysia
Sponsor: United States Naval Medical Research Unit 2 (NAMRU 2)
Research Contract N4034517P0197 (Aug 2017-Jan 2019)
Amount awarded: USD 125,195 (RM 513,000).

National (Malaysia) Principal Investigator/Coordinator
Project Title: PRactice of VENTilation in Middle–Income Countries (PRoVENT–iMIC) – a prospective international multicentre observational study in intensive care units in Asia (completed in January 2019)
Sponsors: The Mahidol Oxford Tropical Medicine Research Unit, Bangkok, Thailand & the Protective Ventilation Network PROVE Network
ClinicalTrials.gov Identifier: NCT03188770

PhD Project
Project Title:The Biochemical and Clinical Outcome Effects of Restricting Chloride-rich Fluids in Critically Ill Patients
Sponsor: Austin Hospital, Melbourne; Australia & New Zealand Intensive Care – Research Centre; Monash University
Supervisors: Rinaldo Bellomo, Anuar Zaini, Michael Bailey

Co-Investigator
Project Title: Transport of the Critically Ill Patient for Pre-Interns (2014-2016)
Sponsors: Monash University Curriculum Development Grant AUD 5,424 (RM 16,097) for development and research of transport of the critically ill curriculum for the medical students)
Monash University Better Teaching Better Learning Grant RM 45,000 for creation of teaching videos of transport of the critically ill for medical students & junior doctors

Principal Investigator
Project Title: Comparison of two different intensive insulin therapy protocols in intensive care. 
Research site: Hospital Sultanah Aminah Johor Bahru
Sponsor: National Institutes of Health, Malaysia (2006). RM 54,000 
National Medical Research Register: 07-819-1091

Sub Investigator
Project Title:LIPOS (Lipid Infusion and Patient Outcomes in Sepsis)
A Prospective, Randomized, Double-blind, Placebo controlled, Dose Ranging, Multi-Centre Study of the Safety and Efficacy of Three Days Continuous Intravenous Infusion of GR270773 in the Treatment of Suspected or Confirmed Gram-negative Severe Sepsis in Adults (2004) 
Research site: University of Malaya Medical Centre
Study Protocol No: EMD 20001

Recent Publications

Publications (in order of Scopus citation count*; last accessed 22 Sep 2019): * total citations: 1,032

Yunos NM, Bellomo R, Hegarty C, Story D, Ho L, Bailey M. Association between a chloride-liberal vs. chloride-restrictive intravenous fluid administration strategy and kidney injury in critically ill adults. JAMA 2012; 308 (15):1566-1572.Scopus citation count: 618

Yunos NM, Bellomo R, Story D, Kellum J. Bench-to-bedside review: Chloride in critical illness Crit Care 2010; 14:26. Scopus citation count: 126

Yunos NM, Kim IB, Bellomo R, Bailey M, Story D, Ho L, Gutteridge GA, Hart GK. The Biochemical Effects of Restricting Chloride-Rich Fluids in Intensive Care (ClinicalTrials.gov NCT 00885404) Crit Care Med 2011; 39(11):2419-2424.Scopus citation count: 108

Yunos NM, Bellomo R, Glassford N, Sutcliffe H, Lam Q, Bailey M. Chloride-liberal vs. chloride-restrictive intravenous fluid administration and acute kidney injury: an extended analysis. Intensive Care Med 2015, 41(2): 257-264.Scopus citation count: 81

Azim N, Wang CY. The use of bispectral index during a cardiopulmonary arrest: a potential cerebral perfusion predictor. Anaesthesia 2004; 59: 610- 612. Scopus citation count: 50  

Young P, Beasley R, Bailey M, Bellomo R, Eastwood GM, Nichol A, Pilcher D, Yunos NM, Egi M, Hart GK, Reade MC, Cooper DJ, for the Study of Oxygen in Critical Care (SOCC) Group. The Association Between Early Arterial Oxygenation and Mortality in Ventilated Patients with Acute Ischaemic Stroke. Crit Care Resusc 2012;14(1):14-19. Scopus citation count: 16

Glassford NJ, Mårtensson J, Eastwood GM, Jones SL, Tanaka A,Wilkman E, Bailey M, Bellomo R, for the GLobal OBservational Evaluations in the ICU (GLOBE-ICU) investigators. GLOBE-ICU participating investigators, Arabi Y, Bagshaw SM, Bannard-Smith J, Bin D, Dubin A, Duranteau J, Echeverri J, Hoste E, Joannidis M, Kashani K, Kellum J, Kulkarni AP, Landoni G, Candal CL, Matejovic M, Yunos NM , Nichol A, van Straaten HO, Perner A, Pettila V, Phua J, Hernandez G, Puxty A, Reinhart K, Richards G, Schneider A, Tsuji I, Uchino S. Defining the characteristics and expectations of fluid bolus therapy: A worldwide perspective. Journal of Critical Care 2016 (35): 126–132. Scopus citation count: 11

Yunos NM, Bellomo R. Letter: Chloride-restrictive fluid administration and incidence of acute kidney injury. JAMA 2013;309 (6):543-544.Scopus citation count: 5

Yunos NM, Bellomo R, Taylor DM, Judkins S, Kerr F, Sutcliffe H, Hegarty C, Bailey M. Renal effects of an emergency department chloride-restrictive intravenous fluid strategy in patients admitted to hospital for more than 48 hours. Emerg Med Australas 2017; doi: 10.1111/1742-6723.12821. Scopus citation count: 5

Pisani L, Algera AG, Neto AS, Ahsan A, Beane A, Chittawatanarat K, Faiz A, Haniffa R, Hashemian R, Hashmi M, Imad HA, Indraratna K, Iyer S, Kayastha G, Krishna B, Moosa H, Nadjm B, Pattnaik R, Sampath S, Thwaites L, Tun NN, Yunos NM, Grasso S, Paulus F, Gama de Abreu M, Pelosi P, Dondorp AM, Schultz MJ, for the PRoVENT–iMIC investigators, MORU and the PROVE network. PRactice of VENTilation in Middle-Income Countries (PRoVENT-iMIC): rationale and protocol for a prospective international multicentre observational study in intensive care units in Asia. BMJ Open 2018; 8:e020841. doi:10.1136/bmjopen-2017-020841. Scopus citation count: 3

Yunos NM, Bellomo R. Letter: Modern medicine is a good goal to seek. Crit Care Med 2012; 40(4):1395

Nor’azim Mohd Yunos. Septic Shock: A Heart Breaking Story. Malaysian Society of Anaesthesiologists Year Book 2007/8

R Atan, N Azim. Management of the patient with multiple injuries CPD Anaesthesia, 2006; 8(2): 68-77

Azim N, Chan L, Vijayan R, Sim DS. Evaluation of Performance of Propofol Target Controlled Infusion System (Diprifusor) in Malaysian Patients. ASEAN Journal of Anaesthesiology 2003; 4 (2): 75-80.

Azim N, Rajan G, Ismail SM , Rahman ZAA, Prepageran N. Acute Upper Airway Obstruction and Severe Hypertension in an Elderly Patient. ASEAN Journal of Anaesthesiology 2003; 4 (2): 37-42

Book chapters

Yunos NM. Approach to fluid therapy in the acute setting. In Ahmad Subhy Alsheihly (ed). Essentials of Accident and Emergency Medicine. InTechOpen 2018. dx.doi.org/10.5772/intechopen.74458 Online ISBN:978-1-78984-833-5

Atan R, Krogh K, Yunos NM, Sood S, Naganathan, Nestel D. Transport of the critically ill patient: Developing safe practices. In Debra Nestel, Michelle Kelly, Brian Jolly, Marcus Watson (eds). Healthcare Simulation Education: Evidence, Theory and Practice.Wiley-Blackwell 2017 ISBN 978-1-119-06159-5

Atan R, Azim N. The multiply injured patient. In Chan Yoo Kuen, Ng Kwee Peng (eds) Management Aspects of Acute Care. University of Malaya Press 2006 ISBN 983-100-403-5

Azim N. Poisoning. In Chan Yoo Kuen, Ng Kwee Peng (eds). Practical Aspects of Acute Care University of Malaya Press 2005; ISBN 983-100-279-2

Research Grants

Current Grants

Principal Investigator
A Passive Surveillance of Dengue and Dengue-Like Illnesses in a Community Clinic in Johor Bahru Malaysia – extended study (under Southeast Asia Biosurveillance & Epidemiology Research SABER program)
Sponsor: United States Naval Medical Research Unit 2 (NAMRU 2)
Research Contract N6264518D5058 (Mar-Sep 2019)
Amount awarded: USD 102,540 (about RM 420,000)

Co-Investigator
A Prospective Study to Evaluate Pathogenic Mechanisms of Severe Disease in Adult Dengue in Malaysia
Sponsor: Monash University Malaysia Tropical Medicine & Biology Seed Fund (a collaboration with Lee Kong Chian School of Medicine, Nanyang Technological University Singapore).
Awarded in Aug 2018.
Amount awarded: RM 8,000

Co-Investigator
Project Title:Comparison of an isotonic balanced fluid, Sterofundin®, with 0.9% saline in traumatic brain injury (TBI): Prospective single centre double-blind randomized controlled trial.
Sponsor: University of Malaya - BKP Grant BK059-2017 
RM 31,000 
Principal Investigator: Khadijah Poh Yuen Yoong (University of Malaya)
ClinicalTrials.gov Identifier: NCT02866604

Previous Grants

Principal Investigator
A Passive Surveillance of Dengue and Dengue-Like Illnesses in a Community Clinic in Johor Bahru Malaysia
Sponsor: United States Naval Medical Research Unit 2 (NAMRU 2)
Research Contract N4034517P0197 (Aug 2017-Jan 2019)
Amount awarded: USD 125,195 (RM 513,000).

Co-Investigator.
Project Title:Transport of the Critically Ill Patient for Pre-Interns (2014-2016)
- Monash University Curriculum Development Grant (for development of transport of the critically ill curriculum for the medical students)
Amount awarded: AUD 5,424 (RM 16,097)

- Monash University Better Teaching Better Learning Grant (for creation of teaching videos of transport of the critically ill for medical students & junior doctors)
Amount awarded: RM 45,000

Principal Investigator.
Project Title:Comparison of two different intensive insulin therapy protocols in intensive care. 
Research site: Hospital Sultanah Aminah Johor Bahru
Sponsor: National Institutes of Health, Malaysia (2006).
RM 54,000
Completed in 2008

Supervision

Higher Degree Research Supervision

Co-supervisor
Student: Dr Ng Wei Yao (2019)
Degree: BMedSc (Hons) Monash
Topic: The association between comorbidities and severe dengue among adult patients: A case-control study

Student: Dr Adam Wong (2018)
Degree: BMedSc(Hons), Monash
Topic: The effects of fluid balance on clinical outcomes of critically ill patients: a prospective observational study

Student: Dr Kevin Chang Yu Wei (2016)
Degree: BMedSc(Hons), Monash
Topic: After­hours discharges in Malaysian Tertiary Intensive Care Units: Impact on outcomes

Student: Dr Hu Su Eng (2016)
Degree: BMedSc(Hons), Monash
Topic: Comparison of electrolytes and haemoglobin measurements between Central Laboratory Analysers and Intensive Care Unit Blood Gas Analysers

Professional Awards & Activities

Awards

  • 2017 Mollie Holman Doctoral Medal
  • PVC’s Award for Excellence in Academic Service, Monash University Sunway Campus 2012
  • PVC’s Award for Excellence in Teaching, Monash University Sunway Campus 2011
  • PVC’s Award for Excellence in Teaching 2008, Monash University Sunway Campus
  • Excellent Service Award 2004, University of Malaya.

Invited Peer-Reviews

  • Malaysian Journal of Medical Sciences 2019
  • BMJ Open 2018
  • Journal of Intensive Care Medicine 2018
  • Intensive Care Medicine 2016.
  • Recommendations of Minimum Standards for Inter-Facility Transport of the Critically Ill Patients by College of Anaesthesiologists, Academy of Medicine Malaysia. 2016.
  • Independent Expert Reviewer for Medical Research Ethics Committee, Ministry of Health Malaysia. 2016 - present
  • The American Journal of Kidney Diseases. 2013.
  • Critical Care. 2013.
  • The New England Journal of Medicine. 2011.
  • Journal of Clinical Anesthesia. 2008.
  • Malaysian Society of Intensive Care Antibiotic Guidelines. 2012, 2017
  • Essential Anaesthesiology for Healthcare Professionals (ISBN: 983-44569-0-0) Department of Anaesthesia and Intensive Care, International Islamic University. 2012.

Invited International Talks

  • Plenary: Crystalloid 2017: Balanced or non-balanced?
    4th SG-ANZICS Intensive Care Forum
    Singapore 20-24 April 2017
  • Fluids and AKI: Does Chloride Matter?
    American Society of Nephrology Kidney Week 2016
    Chicago USA 17-21 November 2016
  • Does Chloride Influence the Development of AKI?
    American Society of Nephrology Kidney Week 2014
    Philadelphia USA 13-16 November 2014
  • 1. The consequences of too much chloride 2. I restrict chloride 3. Acid-base: a practical approach
    11th Congress of the World Federation of Societies of Intensive & Critical Care Medicine
    Durban, South Africa. 28 August – 1 September 2013

Invited National-Level Talks

  • Rethinking fluids for the kidney.
    Malaysian Annual Scientific Meeting on Intensive Care
    Kuala Lumpur 6-8 September 2019
  • Renal support in ICU: a smart water filter
    Malaysian Society of Anaesthesiologists Scientific Congress
    Ipoh, Malaysia. 4-7 July 2019
  • Plenary: Getting smart with fluids in the critically ill.
    Malaysian Annual Scientific Meeting on Intensive Care
    Kuala Lumpur 21-23 September 2018
  • Revisiting Lactate in Sepsis and Haemodynamics
    Malaysian Annual Scientific Meeting on Intensive Care
    Kuala Lumpur 22-24 September 2016
  • Mastering the basic sciences: could we do better?
    Malaysian Society of Anaesthesiologists Scientific Congress
    Kuala Lumpur, Malaysia. 25-28 August 2016
  • Working Together for Patient Safety
    Malaysian Society of Anaesthesiologists Scientific Congress
    Penang, Malaysia. June 2015
  • Chloride and AKI: what we know so far
    Malaysian Annual Scientific Meeting on Intensive Care
    Kuala Lumpur 15-17 August 2014
  • Revisiting Acid-Base in the Critically Ill
    Malaysian Society of Anaesthesiologists Scientific Congress
    Kuala Lumpur. 2 – 6 April 2014.
  • Balanced Review of Balanced Solutions
    Malaysian Annual Scientific Meeting on Intensive Care
    Kuala Lumpur, 28 – 30 Sep 2012
  • Nursing’s Future: Challenges and Opportunities (from a doctor’s perspective).
    2nd Johor Nursing Scientific Conference
    Johor Bahru, 26-27 July 2011
  • Fluid Balance in Sepsis
    Malaysian Annual Scientific Meeting on Intensive Care
    Kuala Lumpur, 15 – 17 July 2011
  • The Effects of Fluid Management on Acid-Base Physiology
    7th National Conference on Intensive Care
    Kota Kinabalu, 3-5 July 2009
  • Management of Critically Ill Patients with Sepsis
    Johor Infectious Disease Symposium
    26 July 2008
  • Assessment of Cardiovascular Failure
    6th National Conference on Intensive Care=
    Kuala Lumpur, 11-13 July 2008
  • Haemodynamic Interactive Session
    5th National Conference on Intensive Care
    Kuala Lumpur, 22-24 June 2007
  • Fluids and Coagulation
    4th National Conference on Intensive Care
    Petaling Jaya, 15-17 September 2006
  • ABC for Paramedics-Circulation
    MSA Annual Scientific Meeting
    Melaka, 17-19 March 2006
  • Hypothermia in the Polytrauma Patient
    3rd National Conference on Intensive Care
    Petaling Jaya, 9-11 September 2005
  • Introduction to Haemodynamic Monitoring
    Pre-conference workshop on Haemodynamic Monitoring
    3rd National Conference on Intensive Care
    Petaling Jaya, 9-11 September 2005
  • Guidelines for Management of Severe Sepsis and Septic Shock
    Surviving Sepsis Campaign 2005-6
  • Anaesthesia and Sedation in Interventional Radiology Basic Interventional Course
    Radiology Department, University of Malaya Medical Centre, June 2005
  • Catheter-related Bloodstream Infection
    4th National Conference on Infection and Infection Control
    Ipoh, 27-29 February 2004

Executive and Committee Roles

  • Deputy Director, Tropical Medicine & Biology (TMB) Multidisciplinary Platform, Monash University Malaysia.2018 – present
  • Executive Committee, Malaysian Society of Intensive Care Medicine (MSIC).

2019 - present

  • Lead, Malaysian Society of Intensive Care Medicine Clinical Trials Group (MSIC CTG). 2019 – present
  • Executive Committee, Malaysian Society for Simulation in Healthcare (MaSSH). 2019 – present
  • Academic Coordinator, BMedSc(Hons) program. Jeffrey Cheah School of Medicine and Health Sciences Executive Committee, Monash University Malaysia
  • Jeffrey Cheah School of Medicine and Health Sciences Executive Committee, Monash University Malaysia 2007-8, 2011– present
  • D-Setara Committee, Jeffrey Cheah School of Medicine and Health Sciences, Monash University Malaysia 2011-2012
  • Honorary Secretary, Intensive Care Medicine Section, Malaysian Society of Anaesthesiologists. 2005/6, 2006/7, 2007/8, 2008/9
  • Pro-tem committee of Malaysian Society of Intensive Care 2008
  • Chair, MBBS Year 3 Curriculum Implementation Committee, Monash University Malaysia 2007-8
  • Co-Editor, MSA Yearbook 2006
  • Executive Committee, Intensive Care Medicine Section, Malaysian Society of Anaesthesiologists. 2003/4 and 2004/5
  • Scientific Committee, 4th National Conference on Intensive Care 2006
  • The MSA Guide to Antimicrobial Therapy in Adult ICU Working Group, Intensive Care Medicine Section, Malaysian Society of Anaesthesiologists.
  • Malaysian Surviving Sepsis Working Group 2004-5
  • Secretary, Organising Committee, 3rd National Conference on Intensive Care 2005

Courses/ Workshops Facilitations

  • Asia Pacific Evidence-Based Medicine Workshop, Singapore 2016-2019
  • Evidence-Based Practice Workshop, Clinical Research Centre, Hospital Sultanah Aminah & Monash University Malaysia 2011-2019
  • Intensive Care Nephrology: Beyond BASIC 2012-19
  • Airway Management: Beyond BASIC 2018
  • Anaesthesiology Physiology Part 1 Refresher Course, Selayang Hospital 2013 & 2015
  • Simulation User Network Workshop 2013
  • iSTAN (Simulation) Training Workshop 2012
  • Basic Assessment and Support in Intensive Care (BASIC) courses (2005-2008)
  • Parenteral Nutrition Workshop 2008, Johor Bahru, Johor
  • Monitoring Workshop 2007, Johor Bahru, Johor
  • Preconference Workshop on Bronchoscopy in ICU, 4th National Conference on Intensive Care 2007

Invited Postgraduate Examinations

  • PhD thesis examiner. International Islamic University Malaysia 2019
  • Intensive Care Subspecialty Viva Exit examination, Ministry of Health Malaysia. 2014, 2016, 2017, 2019
  • PhD confirmation. International Islamic University College Selangor 2015