Management of Internal Disc Derangement Using Normal Saline and Sodium Hyaluronate: A Comparative Study.

BACKGROUND: Arthrocentesis of the temporomandibular joint (TMJ) is the unadorned form of surgical therapy which comprises of lavage of inflammatory enzymes and mediators and improve joint mobility and eliminate pain by pressure of the lavage solution in the upper compartment of TMJ. OBJECTIVES: The current study was conducted to assess and compare the effectiveness of arthrocentesis with normal saline alone and in conjunction with sodium hyaluronate (SH) injection in the treatment of internal derangement of the TMJ. METHODOLOGY: Sixty patients with internal derangement of the TMJ were randomly divided into two equal groups; Group 1 was performed with normal saline and Group 2 with normal saline followed by 1 ml of SH. The patients were followed up after 1 week to check for any postoperative complications and 1, 2, and 3 months for subsequent sessions and changes in subjective and objective variables. RESULTS: The increase in mouth opening from preoperative to 3 months' postoperatively was 4.9 mm for Group 1 and 6.43 mm for Group 2. The change in the pain score (visual analogue scale scale) in Group 1 from the preoperative session to 3 months' follow-up was 7.23-4.1 and in Group 2 was 7.36-3.7. The difference in clicking/popping in Group 1 from preoperative session to 3 months' follow-up was 2.43-1 and in Group 2 was 2.4-0.53. CONCLUSION: Patients refractory to conservative treatment showed promising results with arthrocentesis with SH than arthrocentesis alone in treatment of TMJ internal derangement.

Potential impurities of anxiolytic drug, clobazam: Identification, synthesis and characterization using HPLC, LC-ESI/MSn and NMR.

During the optimization of process, eight impurities (CLB Imp-A to CLB Imp-H) were detected in few of the laboratory batches of clobazam, used as anxiolytic agent, in the range of 0.02-0.12% using gradient HPLC method with UV detection. On the basis of co-spiking analysis, six impurities (CLB Imp-A to -F) enumerated by European Pharmacopoeia, however, not reported in the earlier literature, have been harmonized and found to be two impurities are completely unknown (CLB Imp-G and -H). These two new impurities structures were presumed based on LC-ESI/MSn study as 8-chloro-1-methyl-5-phenyl-1,5-dihydro-3H-1,5-benzodiazepine-2,4-dione (CLB Imp-G) and 5-chloro-1-methyl-3-phenyl-1H-benzo[d]imidazol-2(3H)-one (CLB Imp-H). The presumed impurities structures were confirmed by their synthesis followed by the complete spectral analysis such as ESI-MS, 1D NMR (1H, 13C and DEPT), 2D NMR (HSQC, HMBC and COSY) and IR, and chromatographic retention time profile. Identification, synthesis, structural characterization, prospects to the formation and controlling of these new impurities were described in detail and reported first in this paper.

Synthesis, isolation, identification and characterization of new process-related impurity in isoproterenol hydrochloride by HPLC, LC/ESI-MS and NMR.

One unknown impurity (Imp-II) during the analysis of laboratory batches of isoproterenol hydrochloride was detected in the level ranging from 0.04% to 0.12% by high performance liquid chromatography with UV detection. The unknown impurity structure was proposed as 4-[2-(propan-2-ylamino)ethyl]benzene-1,2-diol (Imp-II) using the liquid chromatography--mass spectrophotometry (LC--MS) analysis. Imp-II was isolated by semi-preparative liquid chromatography from the impurity-enriched reaction crude sample. Its proposed structure was confirmed by nuclear magnetic spectroscopy such as 1H, 13C, DEPT (1D NMR), HSQC (2D NMR) and infrared spectroscopy (IR), and retention time and purity with HPLC followed by the chemical synthesis. Due to less removable nature of Imp-II during the purification, the synthetic process was optimized proficiently to control the formation of Imp-II below to the limit<0.12% in the course of reaction. The new chemical route was developed for the preparation of this impurity in required quantity with purity to use as reference standard. The most probable mechanism for the formation of Imp-II was discussed in details.

Four process-related potential new impurities in ticagrelor: Identification, isolation, characterization using HPLC, LC/ESI-MS(n), NMR and their synthesis.

Five process-related impurities were detected in the range of 0.08-0.22% in ticagrelor laboratory batches by HPLC and LC-MS methods. These impurities were named as TIC Imp-I, -II, -III, -IV and -V. Four of these impurities, TIC Imp-I to -IV were unknown and have not been reported previously. Based on LC-ESI/MS(n) study, the chemical structures of new impurities were presumed as (1S,2S,3S,5S)-3-(2-hydroxyethoxy)-5-(7-amino-5-(propylthio)-3H-[1,2,3]triazolo[4,5-d] pyrimidin-3-yl)cyclopentane-1,2-diol (TIC Imp-I), (1S,2S,3S,5S)-3-(7-((1R,2S)-2-(3,4-difluorophenyl)cyclopropylamino)-5-(propylsulfinyl)-3H-[1,2,3]triazolo [4,5-d]pyrimidin-3-yl)-5-(2-hydroxyethoxy)cyclopentane-1,2-diol (TIC Imp-II), (1S,2R,3S,4S)-4-(7-((1R,2S)-2-(3,4-difluorophenyl)cyclopropylamino)-5-(propylthio)-3H-[1,2,3]triazolo[4,5-d]pyrimidin-3-yl)cyclopentane-1,2,3-triol (TIC Imp-III) and (3S,5S)-3-(7-((1R,2S)-2-(3,4-difluorophenyl)cyclopropylamino)-5-(propylthio)-3H-[1,2,3]triazolo[4,5-d]pyrimidin-3-yl)-5-(2-hydroxyethoxy)cyclopentane-1,2-diol (TIC Imp-IV). The unknown impurities were isolated from enriched crude sample by column chromatography and preparative HPLC. The complete spectral analysis, MS, 1D NMR ((1)H, (13)C and DEPT), 2D NMR (HSQC and HMBC) and IR confirmed the proposed chemical structures of impurities. Identification, isolation, structural characterization, prospects for the formation of impurities and their synthesis were first reported in this paper.

Identification, isolation and characterization of potential process-related impurity and its degradation product in vildagliptin.

Vildagliptin is a member of a new class of oral anti-diabetic drug. One unknown impurity was identified in the range of 0.01-0.06% in different laboratory batches of vildagliptin along with known impurities by HPLC analysis. The structure of unknown impurity was proposed as (2S)-1-[2-[(3-hydroxyadamantan-1-yl)imino]acetyl]pyrrolidine-2-carbonitrile (Impurity-E) using LC/ESI-MS(n) study. The unknown impurity was found to be unstable in diluent (H2O:CH3CN) and degrading into another stable impurity. The degraded stable impurity was isolated from enriched reaction crude sample by semi preparative liquid chromatography. The structure of stable impurity was established using FT-IR, NMR ((1)H, (13)C and DEPT), 2D NMR (HSQC, HMBC and COSY) and mass spectral data as (8aS)-3-hydroxy-octahydropyrrolo[1,2-a]piperazine-1,4-dione (Impurity-F). Impurity identification, abnormal behaviour of impurity-E, isolation of impurity-F, fragmentation mechanism and structural elucidation were also discussed.

A new commercially viable synthetic route for donepezil hydrochloride: anti-Alzheimer's drug.

An economical new process has been developed for the synthesis of donepezil hydrochloride (1) an anti-Alzheimer's drug. The process involves Darzen reaction of pyridine-4-carboxaldehyde and 2-bromo-5,6-dimethoxy indanone affording epoxide 5,6-dimethoxy-3-(pyridine-4-yl)spiro[indene-2,2'-oxiran]-1(3H)-one (4) as a key intermediate. The one-pot deoxygenation of 4 and hydrogenation of the aryl moiety in high yield improved the overall yield of the process.