Browsing by Author "Karki, Sabin"

Now showing 1 - 4 of 4
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    A Case of Uterine Sarcoma: The Impact of Insurance Policy on Timely Access to Hysterectomy
    (2024-03-22) Bell, Kameron; Cook, Myanna; Karki, Sabin; Sakbun, Vannara
    Background: Uterine sarcoma, a uterine cancer subtype, is a rare, aggressive malignancy with non-specific symptoms, complicating early diagnosis and management. Its common symptom, abnormal uterine bleeding, can be mistaken for benign uterine fibroids, leading to treatment delays and poor prognosis. Case: A 41-year-old premenopausal female with a smoking history presented with persistent heavy uterine bleeding for over 6 months. Physical examination and transvaginal ultrasound suggested a 13-week gestational size bulky uterus and a 6.3 x 7.32 cm intrauterine fibroid, respectively. Despite these findings, hysterectomy request was denied by insurance. After a year of continued bleeding, insurance approved the surgery. During the robotic-assisted laparoscopic hysterectomy, anterior and sidewall adhesions raised malignancy suspicion. The surgical team performed a total abdominal hysterectomy, bilateral salpingo-oophorectomy, and right colectomy. Post-operative pathology confirmed uterine sarcoma. Clinical Significance: This case highlights the impact of insurance decisions on patient care, emphasizing timely interventions' necessity and the challenges in distinguishing benign fibroids from uterine malignancy in symptomatic patients. Current literature underscores the diagnostic dilemma surrounding uterine sarcoma, especially differentiating it from benign uterine fibroids. A significant literature gap exists regarding insurance policy impact on accessing timely surgical interventions like hysterectomy, affecting uterine sarcoma prognosis and management. Conclusion: Abnormal uterine bleeding can indicate benign uterine fibroids or uterine sarcoma. In this case, the lack of alternative diagnostics and poor imaging differentiation necessitated a hysterectomy for diagnosis. The delay in insurance approval for surgery underscored the significant impact of insurance decisions on patient care, potentially exacerbating the prognosis and delaying necessary intervention for uterine sarcoma.
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    A Glimpse into Menstrual Health Literacy in Appalachian Ohio
    (American Medical Women's Association (AMWA) 108th Annual Meeting, 2023-03-24) Cook, Myanna; Yeend, Brianna; Karki, Sabin; Stephanian, Brooke; Richcreek, Stephanie
    Evidence supports that health literacy is intricately linked to education level. Appalachian Ohio reports the second lowest percentage of postsecondary education in Appalachian states, which falls 10% below the national average. Coshocton, Ohio is located in North Central Appalachia and is classified as a high poverty rural area. Prior research has established that youth across the United States often lack adequate menstrual health education, which could lead to delayed recognition of serious health issues. Currently, the Ohio Department of Education does not require menstrual education as part of broader sexual health education in schools. Given the low rates of higher education, and thus health literacy, along with lack of state required menstrual education, low levels of menstrual health literacy might disproportionately affect this area. Within the same month at an outpatient clinic in Coshocton, Ohio, two adolescent females and their mothers, who also grew up in Appalachian Ohio, presented with menstrual concerns. Both parties expressed concerns about early menarche, cycle length, menstrual flow, and clots. In both cases, the patients were experiencing clinically normal menstruation. The patients and their mothers were counseled on normal range menses. Research surrounding menstrual health literacy in rural areas is lacking. The presented cases may point to a pattern of inadequate menstrual education in Coshocton, Ohio, as the patients and parents were unaware of normal menstrual patterns. In order to progress patient care, further research should aim to discern whether this area and greater Appalachia demonstrate lower levels of menstrual health literacy. Patients in Appalachia demonstrate lower education levels, which is correlated to lower health literacy. These cases highlight potentially inadequate menstrual education in Coshocton, Ohio. Further research and improved menstrual education should be pursued in the area.
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    Advancing AI in Medical Education: Understanding the Malpractice Landscape
    (2024-04-26) Stephanian, Brooke; Karki, Sabin; Schantz, Eli
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    Ethical Boundaries in AI-Driven Medical Education: Safeguarding Patient Data
    (2024-04-26) Karki, Sabin; Stephanian, Brooke; Schantz, Eli