Biomedical subjects

Srinivas M Susarla

Publications and source records attributed to Srinivas M Susarla.

7 recordsLinked to original sources

PubMed2005

How well do clinicians estimate third molar extraction difficulty?

PURPOSE: The goals of this study were to measure surgeons abilities to estimate third molar (M3) extraction difficulty and to identify variables associated with errors in estimates of difficulty. MATERIALS AND METHODS: To address our research purpose, we implemented a prospective cohort study and enrolled a sample of surgeons who remove M3s. Predictor variables were categorized as either surgeon or subject specific. The primary outcome variable was the error in estimating operative difficulty. Preoperative and postoperative estimates of difficulty were obtained using a 100-mm visual analogue scale. Error was defined as the difference between preoperative and postoperative estimates of extraction difficulty. Appropriate univariate, bivariate, and multivariate statistics were computed. RESULTS: The sample was composed of 15 surgeons who operated on 82 subjects having 250 M3s (53.2% mandibular) extracted. The mean level of surgical experience was 8.8 +/- 11.1 years. The mean age of the subjects was 26.2 +/- 10.7 years; 57.3% were female; and 72.0% were white. The mean preoperative and postoperative estimates of difficulty were 44.3 +/- 23.4 and 39.6 +/- 24.7 mm, respectively. The mean absolute and actual differences between preoperative and postoperative estimates were 15.7 +/- 13.6 and 4.8 +/- 20.2 mm, respectively. We identified several demographic and anatomic variables statistically associated ( P < or = .05) with error in estimating difficulty. CONCLUSIONS: Our models indicate that errors in the estimates of difficulty were related to demographic (age, gender, ethnicity, snoring) and anatomic (cheek flexibility, mouth opening) variables, with little or no dependence on radiographic variables or surgical experience.

Adolescent↗

PubMed2005

Estimating third molar extraction difficulty: a comparison of subjective and objective factors.

PURPOSE: The purpose of this study was to compare and contrast subjective and objective assessments of variables associated with third molar (M3) extraction difficulty. MATERIALS AND METHODS: To address the research purpose we implemented a prospective cohort study and enrolled a sample of surgeons removing M3s in an ambulatory care setting. Predictor variables were categorized as demographic, anatomic, or operative. The outcome variables were subjective and objective rankings of the importance of the variables in terms of estimating M3 extraction difficulty. Subjective rankings were made by surveying the surgeons and asking them to rank each variable's importance on a scale ranging from 0 (not important) to 100 (extremely important). Objective rankings of each variable's importance were made using the absolute values of coefficients derived from a multivariate linear regression model with extraction time as the outcome. Appropriate uni-, bi-, and multivariate statistics were computed. RESULTS: The sample consisted of 14 surgeons who removed 450 M3s from 150 subjects from June 2002 to August 2003. Based on the multivariate linear regression model, variables associated with M3 extraction time were gender, arch location, Winter's classification, tooth morphology, number of teeth extracted, procedure type, and surgical experience. For these variables, there was a strong, statistically significant correlation (r = 0.86; P <.01) between the standardized coefficient absolute values and the surgeons' estimates of importance. CONCLUSION: There was a large, positive correlation between variables that surgeons consider most important in determining M3 extraction difficulty and those exhibiting the most influence over extraction times in a multivariate model.

Adult↗

PubMed2004

Risk factors for third molar extraction difficulty.

PURPOSE: The purpose of this study was to measure the difficulty of third molar (M3) extractions and to identify demographic, anatomic, and operative variables associated with extraction difficulty. MATERIALS AND METHODS: To address the research purpose, we implemented a prospective cohort study and enrolled a sample composed of patients presenting for M3 removal. Predictor variables were categorized as demographic, anatomic, and operative. The primary outcome variable was difficulty of extraction, measured as extraction time per tooth. The secondary outcome variable was the surgeons postoperative estimate of M3 extraction difficulty, measured on a 100-mm visual analog scale (VAS). Appropriate univariate, bivariate, and multivariate statistics were computed. RESULTS: The sample was composed of 82 subjects, having 250 M3s (53.2% mandibular) extracted, with a mean age of 26.2 +/- 10.7 years; 57.3% were female, 72.0% were white. The mean operating time per M3 extraction was 6.9 +/- 7.6 minutes. The mean estimate of difficulty was 39.6 +/- 24.7 mm and was significantly correlated (r = 0.68) with extraction time (P < .01). Surgical experience, M3 location (maxillary versus mandibular), procedure type, tooth position, number of teeth extracted, and tooth morphology were statistically associated (P < or = .05) with extraction time in a multivariate model. CONCLUSION: Our model indicates that the difficulty of M3 extractions is governed primarily by anatomic and operative factors with minimal influence from demographic factors.

Adolescent↗

PubMed2004

Canalicular adenoma of the palate: case report and literature review.

Canalicular adenoma is a rare benign salivary gland tumor of the oral cavity, typically located in the upper lip and buccal mucosa and infrequently found on the palate. The tumor is usually confined to soft tissue and rarely presents with bone erosion. A case of a large and locally-aggressive palatal canalicular adenoma is presented. The lesion presented herein was an asymptomatic ulcerated mass with significant bone erosion. The tumor was managed surgically with excision and reconstruction of the resulting palatal defect with a full temporalis muscle flap.

Adenoma↗

PubMed2004

Problem-based learning and research at the Harvard School of Dental Medicine: a ten-year follow-up.

Dental students at the Harvard School of Dental Medicine (HSDM) are required to pursue and complete research projects in order to obtain the doctor of dental medicine (D.M.D.) degree. The purpose of this study was to evaluate the effect of curriculum changes on a set of measurable outcomes related to research pursuits. This study was designed as a retrospective analysis of outcomes data from the period 1992-2002. The predictor variable was program format (non-PBL vs. PBL); the outcome variables were the percentage of students listed as authors on an IADR/AADR abstract during their tenure at HSDM and the percentage of students listed as first and/or presenting authors. Univariate statistics were computed for each class, and independent samples t-tests were used to compare the study groups with regard to our outcomes. For the majority of our outcomes, there was no statistically significant difference between the PBL and non-PBL groups, possibly due to sample size limitations. While the implementation of PBL at HSDM has not universally increased student productivity in research, it has not had an adverse effect either. It is possible that students in the PBL curriculum are nurturing other interests, such as community service, while retaining productivity in research.

Dental Research↗

PubMed2003

Reversing established sepsis with antagonists of endogenous high-mobility group box 1.

Despite significant advances in intensive care therapy and antibiotics, severe sepsis accounts for 9% of all deaths in the United States annually. The pathological sequelae of sepsis are characterized by a systemic inflammatory response, but experimental therapeutics that target specific early inflammatory mediators [tumor necrosis factor (TNF) and IL-1beta] have not proven efficacious in the clinic. We recently identified high mobility group box 1 (HMGB1) as a late mediator of endotoxin-induced lethality that exhibits significantly delayed kinetics relative to TNF and IL-1beta. Here, we report that serum HMGB1 levels are increased significantly in a standardized model of murine sepsis, beginning 18 h after surgical induction of peritonitis. Specific inhibition of HMGB1 activity [with either anti-HMGB1 antibody (600 microg per mouse) or the DNA-binding A box (600 microg per mouse)] beginning as late as 24 h after surgical induction of peritonitis significantly increased survival (nonimmune IgG-treated controls = 28% vs. anti-HMGB1 antibody group = 72%, P < 0.03; GST control protein = 28% vs. A box = 68%, P < 0.03). Animals treated with either HMGB1 antagonist were protected against the development of organ injury, as evidenced by improved levels of serum creatinine and blood urea nitrogen. These observations demonstrate that specific inhibition of endogenous HMGB1 therapeutically reverses lethality of established sepsis indicating that HMGB1 inhibitors can be administered in a clinically relevant time frame.

Animals↗

PubMed2003

Problem-based learning: effects on standard outcomes.

Dental students at the Harvard School of Dental Medicine (HSDM) participate fully in the first two years of the curriculum with the Harvard Medical School (HMS) while also taking parallel dental classes. HSDM students were first exposed to problem-based learning (PBL) in 1987 when the "New Pathway" curriculum was introduced at HMS in the first two years of the medical school curriculum (the HSDM courses remained traditional lecture-based classes). In 1994, HSDM incorporated PBL into the first, second, and third (clinical year) year dental courses, and the curriculum shifted from a five-year curriculum to a four-year curriculum. The purpose of this study was to evaluate the effect of PBL and program length on measurable outcomes for dental education: NBDE Part I scores, attrition and graduation rates, and percentage of graduates entering postdoctoral training programs. This study was designed as a retrospective analysis of outcomes data from 1980 to 2002. Univariate linear regressions were computed for each measure against each outcome. Subsequent bivariate regression analyses revealed that the implementation of PBL has markedly affected NBDE Part I scores, graduation rates, attrition rates, entrance into postdoctoral plans, and percentage of graduates entering GPR/AEGD programs, while program length has had an effect on graduation rates, attrition rates, entrance into postdoctoral programs, and percentage of graduates entering GPR/AEGD programs. The findings of this report suggest that the implementation of PBL combined with a change in program length has been successful for all outcomes measured and that PBL alone has contributed to the rise in NBDE Part I scores among HSDM graduates.

Boston↗