Study Report of use of "Pinak" - at Govt. Sasun Hospital, Pune

STUDY OF PINAK TABLET IN SNAKEBITE / COMPARATIVE STUDY OF PINAK WITH ASV IN SNAKEBITE - IN Govt. SASOON HOSPITALS, PUNE, Maharastra, India.
 
There are lots of patients with poisonous snakebite admitted to this hospital every year. ASV is an important drug for the same. Due to cost and poor availability of ASV present study was undertaken. Pinak is oral tablet approved for snakebite by ayurvedic Drug formulation. This study was undertaken to find out effectivity of Pinak when used as adjuvant therapy to ASV in snakebite patients. Ethical committee approval was taken for the same.
AIMS & OBJECTIVES:

1. To assess role of Pinak in relation to quantity of ASV required, occurrence of complications, morbidity, and mortality in two groups i.e. ASV alone and ASV with Pinak.

MATERIALS AND METHODS:
Present pilot study was conducted in Sasoon General Hospitals, Pune Medicine Department in different medical units and Rural Hospital, Ghodegaon, Dist. Pune in the year 2006.
Patients admitted with alleged history of snake bite and occult snakebite. Patients with complication who require ASV and further treatment are enrolled in study group and control group.
Patients were clinically evaluated as per clinical protocol. Patients with complicated snakebite admitted in one medical unit who received ASV and Pinak tablet considered as study group and patients of other units who received only ASV were considered as control group.
Pinak tablets were given sublingually immediately after admission. Then examination was done. IV line secured and ASV given. Pinak was given 4-6 hourly as per requirement were given. Patients were closely observed for reaction to tab Pinak, relief of symptoms, generalized well being, pain at bite site, reduction of swelling, decreasing neurological symptoms, and requirement of ventilator.

OBSREVATION TABLES:
Table no. 1
Age and sex wise distribution

1. Neurotoxic

Table no. 2
Age and sex wise distribution

1. Vasculotoxic

Table no. 3
Complications

DISCUSSION:

We studied 28 patients of poisonous snakebite. It includes vasculotoxic and neuroparalytic snakebites. We divided them as control group 13 patients who received only ASV and study group 15 patients who received ASV and Pinak.  We analyzed them statistically.

1. No statistical significant difference was found in these two groups in relation to age and sex distribution, time of bite and presentation to hospital. Time of onset of symptoms after bite between study and control groups was not statistically significant. ( t =1.97 DF = 26, p > 0.05). In Pinak group mean 15.4 SD = 21.9, M = 15. In control group mean = 3.36, SD = 2.04, N=13.
2. No. of ASV required in study group of neuroparalytic snakebite (3 patients) and control group (4 patients). No statistical difference was found. Mean ASV required 21.3 vials SD = 16.2, M =3, in study group. In control group mean ASV required 44.5 vials. SD  =12.26, M = 4. t = 2.7, DF = 5, p >0.05. Mean no. of Pinak tablets used were
      9. 6. SD = 7.76.
3. Vasculotoxic snakebite are graded as I ( 9/6), II ( 3/20, III ( 0/1)
      according to clotting time. In vasculotoxic snakebite, presentation of
       patients after bite between two groups, there was no statistical 
       difference found.

1. No. of ASV vials required in vasculotoxic snakebite were a) Pinak group mean 21 and b) control group 62. This difference was statistically significant. (P < 0.05). No. of Pinak tablets required were 6.16 standard deviation 7.76.
2.  Total consumption of ASV vials in all types of snake bite in study group were mean 21.8, standard deviation 21.6 and in control group were mean 56.6 and standard deviation 30.3. Difference in ASV consumption per patient was statistically significant ( P <0.05). In Pinak group mean ASV vial = 21.8, SD = 21.6, M = 15. In control group mean ASV vials = 56.6, SD = 30.3, M=13, t= 3.57, DF=26
3. Three patients had DIC in control group. None had DIC in Pinak group. As shown in the table complications in Pinak group recovered earlier than control group.
4. In neuroparalytic snakebite, ventilator time was statistically significantly less in Pinak group than only ASV group.
5. No reaction to Pinak was found. No deaths were observed in patients of Pinak group.
6. Pinak is easy to administer

SUMMARY AND CONCLUSION:

In our pilot study of 28 patients of complicated snakebite, 15 patients received Pinak + ASV and control group 13 patients received only ASV.
Following observations were found:

1. No. of ASV vials requirement was less in Pinak group than control group. P < 0.05.
2. In neuroparalytic snakebite no significant difference was found in ASV requirement, but in vasculotoxic snakebite statistical significant difference was found in ASV requirement.
3. Complications are minimal, of less severity in Pinak group as compared to control group.
4. In neuroparalytic group recovery is fast in Pinak group and required less duration of ventilatory support as compared to control group.
5. No mortality, reaction to Pinak tablet was observed.
6. This is a Pilot study. Further detailed study with large no. of patients is required for definite recommendations.

Thus we conclude that Pinak tablet has supporting role in complicated snakebite but not substitute for ASV. Pinak has found to have reduced ASV requirement significantly.

                                                                       Dr D. B. kadam
                                                                       Professor of Medicine,
                                                                       Sassoon General Hospital,
                                                                       Pune.

<<<