Monday, 7 May 2018

Nor'azim Yunos, winner of Mollie Holman medal



For the second year running, we’re thrilled to announce that our School has two winners of the annual Mollie Holman Medal. The medal is awarded to those students judged to have presented the best doctoral thesis each year. 

Nor’azim Mohd Yunos completed his thesis last year, under the joint supervision of the Jeffrey Cheah School of Medicine & Health Sciences, Monash University Malaysia, and the ANZIC-Research Centre, based here at our School.

Nor’azim’s thesis was entitled “The Biochemical and Clinical Outcome Effects of Restricting Chloride-rich Fluids in Critically Ill Patients,” and he was supervised by Professor Anuar Zaini, Professor Rinaldo Bellomo and Professor Michael Bailey.

Delivery of intravenous fluids for resuscitation and other purposes is common in acute settings, such as emergency departments and critical care wards. It is especially common among the critically ill, and millions of litres of these fluids are given worldwide every day. Despite this, some animal and human volunteer studies had raised concerns on the side-effects of chloride-rich intravenous fluids. Given the huge volumes delivered globally, even a small difference in outcomes could have a significant impact. 

Nor’azim’s studies set out to investigate the effects of these chloride-rich fluids on critically ill patients. The team conducted a prospective before-and-after trial in the Intensive Care Unit (ICU) of Austin Hospital, Melbourne. The control group consisted of more than 700 patients consecutively admitted in 6 months, who received standard fluid prescriptions predominated by the chloride-rich 0.9% saline. After a washout period, a 6-month intervention on a similar number of ICU patients followed; with the prescriptions now restricted to only fluids with lower chloride contents. The team also explored the extension of this intervention in the ICU for one-year period, as well as the effects of a similar chloride-restrictive intervention on the Emergency Department patients.

They found that chloride-rich fluids, chiefly the 0.9% saline or commonly known as 'normal saline', was associated with poorer acid-base and renal outcomes. The ICU cohort of patients that received chloride-rich fluids had a higher incidence of severe acidosis, acute kidney injury and had a greater need for renal replacement therapy.

The study was the first to explore the effects of chloride-rich fluids in the critically ill cohort, and the findings generated great interest in the intensive care circle. The new knowledge influenced clinicians to be more prudent with their choice of fluids for the critically ill. It also set the stage for larger studies with improved design to address the important goal of getting the right mixture for the intravenous fluids.

Nor’azim did his PhD on a part-time basis while serving as an academic with the Clinical School Johor Bahru, Monash University Malaysia, and a sessional intensivist with the Sultanah Aminah Hospital Johor Bahru. He is also now the Deputy Head (Research) of the Clinical School.

Nor’azim says of his win, “I’m so deeply honoured and grateful! I’m greatly indebted to all my supervisors: Anuar Zaini for paving the way to the PhD, Rinaldo for all his knowledge, wisdom and incredible patience and Michael for his invaluable stats guidance. Special thanks to my beloved PhD partner, my wife Rafidah who also graduated with me; and to our four boys for whom we hope this PhD journey had been inspiring.”

Huge congratulations Nor’azim, a wonderful achievement!