Journal of the Pakistan Medical Association publishes original material of interest to the practitioners and scientists in the broad field of medicine. Articles describing original clinical or laboratory investigations and case reports will be considered for publication. From time to time invited articles, editorials and review of selected topics will be published. Manuscripts, including illustrations and tables must be original and not under consideration by another publication.

Journal of the Pakistan Medial Association has agreed to receive manuscripts in accordance with the "Uniform Requirements for Manuscripts Submitted to Biomedical Journals," as cited in N. Engl. J. Med., 1997,336:309-15. In preparing manuscripts, authors should follow the "Uniform Requirements for Manuscript Submitted to Biomedical Journals" and specific author instructions detailed below:

Submit two copies of the manuscript and two copies of the figures along with a soft copy (CD) to: Editor, Journal of the Pakistan Medical Association, PMA House, Aga Khan III Road, Karachi-74400, Pakistan.

The Journal's phone / fax number is (9221)-2226443, (021) 5418192 and email is jpma_jpma@hotmail.com. Original manuscripts will not be accepted by Facsimile, but for other communications the Fax # (021) 2226443 may be used. Email may be used for manuscript submission.

All manuscripts should be accompanied by a covering letter from the author responsible for correspondence regarding the manuscript. Mention submission type in your cover letter. The covering letter should contain the following copyright disclosure statement.

The covering letter should also contain statement that the manuscript has been seen and approved by all authors and should give any additional information which may be helpful to the Editor. If there has been any prior publication of any part of the work, this should be acknowledged and appropriate written permission included. If colour illustrations are included, a statement that the author(s) is (are) willing to bear the cost of colour separation and reproduction is requested.

The manuscript may be submitted online as an attachment in MS Word by email on the address jpma_jpma@hotmail.com. Original Photographs and figures should either be sent by surface mail or scanned and emailed through JPG image.

All authors and co-authors should sign the following disclosure statement, by virtue of which they are responsible for the content of the article and giving all copyrights to the Journal of Pakistan Medical Association:

“Upon acceptance by Journal of the Pakistan Medical Association, all copyright ownership for the article is transferred to the Journal of Pakistan Medical Association. We, the undersigned, principal author and co-authors of this article, have contributed significantly to and share in the responsibility for above. The undersigned stipulate that the material submitted to Journal of the Pakistan Medical Association is new, original and has not been submitted to another publication for concurrent consideration.

We also take the moral and ethical responsibility of not using unfair means such as plagiarism, duplicate publication, cross referencing, copying verbatim statements from other sources without acknowledgement in preparing this manuscript.

We also attest that any human and /or animal studies undertaken as part of the research from which this manuscript was derived are in compliance with regulation of our institution(s) and with generally accepted guidelines governing such work.

We further attest that we have herein disclosed any and all financial or other relationships which could be construed as a conflict of interest and that all sources of financial support for this study have been disclosed and are indicated in the acknowledgement.

A non-refundable processing fee of Rs 500/- will be charged along with the "JPMA donation account". No processing fee will be charged for editorial and letter to the editor.

Submitted manuscripts are reviewed for originality, significance, adequacy of documentation, reader interest and composition.

Manuscript not submitted according to instructions will be returned to the author for correction prior to beginning the peer review/process. Revised manuscripts are judged on the adequacy of responses to suggestions and criticisms made during the initial review.

All accepted manuscripts are subject to editing for scientific accuracy and clarity by the office of the Editor.

A. General Requirements
Manuscript must be written in English. Whenever there is any doubt, authors should seek the assistance of experienced, English-speaking medical editors. A medical editor should review the final draft of the original and any revision of the manuscript.

Type the manuscript on A4 size white bond paper, 8-1/2x11 inches (21.6x27 cm) with margins of at least 1.5 inches (4 cm). Type on one side of the paper only double spacing every page. Begin each of the following section on separate page and in the following order: title page, abstract, introduction, materials / subjects / patients and methods, results, discussion, acknowledgements, references, tables and figures (each on a separate page) and legends. Number pages consecutively, beginning with the title page. Type the page number in the upper right-hand corner of each page.

B. Title Page
The title page of the manuscript should include: (1) concise and informative title (less than 200 characters); (2) complete by line, with first, middle initial and last name of each author up to ten authors may be cited; (3) complete affiliation for each author, with the name of department (s) and institution (s) to which the work should be attributed; (4) disclaimer, if any; (5) name, address and telephone number and email address (necessary) of one author responsible for correspondence about the manuscript; (6) name and address of author to whom reprint request should be directed, or statement that reprints are not available from the author; (7) source(s) of support in the form of grants equipment, drugs, or all of these; (8) word count.

C. Abstracts
Provide on a separate page a structured abstract of not more than 250 words for original article and an unstructured abstract of no more than 150 words for other submission types. The structured abstract should consist of four paragraphs, labeled Objective, Methods, Results and Conclusion. They should briefly describe, respectively, the problem being addressed in the study, how the study was performed, the salient result and what the authors conclude from the results. The unstructured abstract is in the form of one paragraph covering these headings.

D. Introduction
State the purpose of the article and summarize the rationale for the study or observation. Give only strictly pertinent references and do not include data or conclusions from the work being reported. Clearly mention the objective(s) of the study in this section without adding any sub-heading.

E. Methods
Describe your selection of the observational or experimental subjects (patients or laboratory animals, including controls) clearly identify the age, sex and other important characteristics of the subjects. The definition and relevance of race and ethnicity are ambiguous. Authors should be particularly careful about using these categories.

Identify the methods, apparatus (give the manufacturer's name and address in parenthesis) and procedures in sufficient detail to allow other workers to reproduce the results. Mention setting, study design, sampling method, sample size, inclusion/exclusion criteria wherever applicable without adding any sub-headings. Give references to established methods if necessary, provide references and brief descriptions for methods that have been published but are not well known; describe new or substantially modified methods, give reasons for using them and evaluate their limitations. Identify precisely all drugs and chemicals used, including generic name(s), dose(s) and route(s) of administration.

Reports of randomized clinical trials should present information on all major study elements including the protocol (study population, interventions or exposures, outcomes and the rationale for statistical analysis), assignment of interventions (methods of randomization, concealment of allocation to treatment groups) and the method of masking (blinding).

Authors submitting review manuscripts should include a section describing the methods used for locating, selecting, extracting and synthesizing data. These methods should also be summarized in the abstract.

F. Ethics
When reporting experiments on human subjects, indicate whether the procedures followed were in accordance with the ethical standards of the responsible committee on human experimentation (institutional or regional) and with the Helsinki Declaration of 1975, as revised in 1983. Do not use patients' names, initials, or hospital numbers, especially in illustrative material. When reporting experiments on animals, indicate whether the institutions or a national research councils guide for or any national law on the care and use of laboratory animals was followed.

G. Statistics
Describe statistical methods with enough detail to enable a knowledgeable reader with access to the original data to verify the reported results. When possible, quantify findings and present them with appropriate indicators of measurements error or uncertainty (such as standard deviation when mentioning mean values of quantitative variables, or confidence intervals where odds ratio is mentioned, etc.). Mention the statistical test used for analysis to obtain the P values. Discuss the eligibility of experimental subjects. Give details about randomization. Describe the method for and success of any blinding of observations. Report complications of treatment. Give numbers of observations. Report losses to observation (such as dropouts from a clinical trial). References (if necessary) for the design of the study and statistical methods should be to standard works when possible (with pages stated) rather than to papers in which the designs or methods were originally reported. Specify any general use computer programs used.

Put a general description of methods in the methods section. When data are summarized in the results section, specify the statistical methods used to analyze them. Restrict tables and figures to those needed to explain the argument of the paper and to assess its support. Use graphs as an alternative to tables with many entries; do not duplicate data in graphs and tables. Avoid non-technical uses of technical terms in statistics, such as "random", (which implies a randomizing device), "normal", "significant","correlations" and "samples". Define statistical terms, abbreviations and most symbols.

H. Results
Present your results in logical sequence in the text, tables and illustrations. Do not repeat in the text all data in the tables or illustrations emphasize or summarize important observations.

I. Discussion
Emphasize the new and important aspects of the study and conclusions that follow from them. Do not repeat in detail data or other material given in the introduction or the results section. Include in discussion section the implications of the findings and their limitations including implications for future research. Relate the observations to other relevant studies.

Link the conclusions with the goals of the study but avoid unqualified statements and conclusions not completely supported by data. In particular, authors should avoid making statements on economic benefits and costs unless their manuscript includes economics data and analyses. Avoid claiming priority and alluding to work that has not bf completed. State new hypothesis when warranted. But clearly label them such recommendations, when appropriate, may be included.

J. Acknowledgements
Persons who have contributed intellectually to the paper but whose contributions do not justify authorship may be named and the function or contribution is described - for example, "scientific advisor critical review of study proposal, "data collection," or "participation clinical trial". Such persons must have given their permission to be named. Authors are responsible for obtaining written permission from person acknowledged by name, because readers may infer their endorsement the data and conclusions. Technical help should be acknowledged in a paragraph separate from those acknowledging other contributions.

K. References
References should be cited in consecutive numerical order at first mentioned in the text and designated by the reference number in parenthesis. References appearing in a table or figure should be numbered sequentially with those in text.

The reference list must be typed double spaced and numbers consecutively, as in the text. The Journal follows Index Medicus style for references and abbreviated journal names according to the list of Journals indexed in Index Medicus. "Unpublished observations" and "personal communications" should not be used as references, although written-not verbal-communications may be noted as such in the text. References cited as "in press" must have been accepted and not merely in preparation or submitted. The author is responsible for the accuracy of all references and must verify them against the original document.

For journal articles, list the first six authors, et al.
SJ Khan, A Hassan, L Khalid, U Karim, E Hashmi, F Gul, et al. Blindness in children at the Ida Rieu school for the blind and deaf. J Pak Med Assoc. 2007; 57: 334 – 337.

For books and book chapters, follow the examples below:
DeGroot IJ. Evaluation of thyroid function and thyroid disease. In: DeGroot L, Stanbury J B, eds. The thyroid and its diseases. 4th ed. New York: Wiley, 1975, pp 196-248.

Dupont B. Bone marrow transplantation in severe combined immunodeficiency with an unrelated MLC compatible donor. In: White H J Smith R, eds. Proceeding of the third annual meeting of the International Experimental Hematology. Houston: International Society for Experimental Hematology, 1974, pp 44-46.
In Press
Leshner AI. Molecular mechanisms of cocaine addiction. N EngI J Med. In press 1996.

Journal article in electronic form
Morse SS. Factors in the emergence of infectious diseases. Emerg Infect Dis [serial online] 1995
Jan-Mar [cited 1996 Jun 5], Computerized Educational Systems, 1993.

Monograph in electronic form
CDI, clinical dermatology illustrated [monographs on CD-ROM] Reeves JRT, Maibach H. CMEA Multimedia group, producers 2nd ed. Version 2.0. San Diego: CMEA, 1995.

Conference proceedings
Kimura J, Shibasaki H, editors. Recent advances in clinical neurophysiology. Proceedings of the 10th International Congress of EMG and Clinical Neurophysiology, 1995 Oct 15-19, Kyoto, Japan. Amsterdam: Elsevier, 1996.

Dissertation
Kaplan SJ. Post-hospital home health care the elderly's access and utilization [dissertation]. St. Louis (MO): Washington Univ., 1995.

Volume with supplement
Shen HM, Zhang QF. Risk assessment of nickel carcinogenicity and occupational lung cancer. Environ Health Perspect, 1994;102 Suppl 1:275-82.

World Wide Web page
Beckleheimer J. How do you cite URL's in a bibliography? [online] 1994 [ cited 2000 Dec 13].
URL: http://www.nrlssc.navy.mil/meta/bibliography.html

World Wide Web page (no author)
Educating America for the 21st century: Developing a strategic plan for educational leadership [online] 1994 [cited 1999 May 15]. Available from:
URL: http://www.ilt.columbia.edu/CONF/Edplan.html

World Wide Web Home page
Curtin University of Technology. [Homepage of the Curtin University of Technology] [online] 2000 May 22 last update. [cited 2000 Jun 12].
Available from: URL: http://www.curtin.edu.au/

Abbreviations and Symbols
With the exception of units of measurement, Journal discourages the use of abbreviations, for additional information on proper medical abbreviation, consult the CBE style Manual, Fifth Edition (Bethesda, MD Council of Biology Editions, 1983). When an abbreviation is used, it should be preceded by the full word or name of the item being abbreviated.

Drug Names
Generic names should generally be used. When proprietary brands are used in research, include the brand name in parentheses in the methods section.

L. Tables
Type each table double-spaced on a separate page. Do not submit tables as photographs. Tables should be self-explanatory and should supplement, not duplicate the text. Each table must be cited in consecutive numerical order in the text. Number the tables consecutively with an Arabic number following the word Table. The titles should be descriptive, brief and typed centered in upper and title, column headings and at the end of the table. Do not use vertical lines. Give each column a short or abbreviated heading.

Place explanatory matter in footnotes not in heading. Use the following symbols in this sequence *,+,++,#,**. Expand in the footnote all non-standard abbreviations used in each table. For footnotes, identify statistical measures of variations, such as standard deviation and standard error of the mean. If data from another published source are used, obtain written permission from the publisher of the original source and acknowledge fully. If data from an unpublished source are used, obtain permission from the principal investigator and acknowledge fully.

M. Illustrations
Illustrations should clarify and augment the text. The selection of sharp, high-quality illustrations is of paramount importance. Figures of inferior quality will be returned to the author for correction or replacement.

Submit two complete sets of glossy illustrations, no smaller than 3-1/2x5 inches nor larger than 8x10 inches. Do not send original artwork.. Glossy photographs of line drawings rendered professionally on white drawing paper in black India ink, with template or typeset lettering, should be submitted. No hand drawn or typewritten art will be accepted. Letters, number and symbols (typeset or template) must be clear and of sufficient size to retain legibility after reduction.

Each illustration must be numbered and cited in consecutive order in the text. Illustrations should be identified on a gummed label affixed to the back of each illustration and containing the following information: figure number, part of figure (if more than one) and designation of "top".

Colour illustrations will be considered for publication, but the author is responsible for all charges relating to separations and printing. An estimate of these charges will be sent to the author at the time of production Authors' approval of charges is required before production will continue. Three complete sets of glossy colour photographs (not transparencies) must be submitted for review. Polaroid prints are not acceptable.

All submitted illustrations become the property of Journal of the Pakistan Medical Association and will not be returned unless the manuscript is rejected.

Legends for illustrations should be concise and should not repeat the text. Legends should be typed double-spaced on a separate page. Each figure should be cited in consecutive numerical order in the text. Give the figures a number following the word Figure. Use letters to designate parts of illustrations (e g , A,B,C) and describe each part clearly in the legend. Any letter designations or arrows appearing on the illustration should be identified and described fully.

Originally (not previously published) illustrations are preferred for publication in the Journal; however, if illustrations have been published previously, authors are responsible for obtaining written permission from the publisher to reprint. The source of the original material must be cited in the references and the following credit line included in the legend. (Reprinted by permission of Ref. X). All permission release must be submitted to the Editor at the time of manuscript submission.

Review article: maximum 4000 words excluding title page and an unstructured abstract of 150 words and references with no more than five tables or figures and 35 references.

Original article: maximum 3000 words excluding title page and a structured abstract of 250 words and references with no more than three tables or figures and 25 references.
Short Reports / Short Communications / Special Communications / Case reports: maximum 1250 words excluding title page and an unstructured abstract of 150 words and references with no more than two tables or figures and 10 references. It should not be signed by more than six authors

Case Report: Abstract; Introduction; Case Report; Discussion and Conclusion.

Short Report: Abstract; Introduction; Patients Methods and Result; and Conclusion.

Special Communication: Abstract; Introduction; Methods and Result; and Conclusion.

Letters to the Editor: maximum 250 words if it is in reference to a recent journal article, or 400 words in all other cases. It must have no more than five references and one figure or table. It must not be signed by any more than three authors. Letters referring to a recent journal article must be received within four weeks of its publication.

Original double-spaced typed manuscript. Mention type of submission in your cover letter with a word count. Provide a soft copy (CD) along with two hard copies.

Two sets of unmounted glossy Figures (no smaller than 3-1/2x5 inches and not larger than 8x10 inches). Copy right transfer.

Title page with title, authors' names and complete affiliations; corresponding author, complete address, telephone number and email address (necessary), author for reprint requests and complete address.

References in consecutive numerical order. Reference list typed double space.

Figures and Tables in consecutive numerical order.

Legends for all figures typed double spaced.

Consent forms for patient photographs.

Written permission from the publisher to reprint previously published figures and tables.

Upon acceptance by the journal, a fees will be charged for publishing the article, which is to be submitted to the office through cross cheque, bank draft or pay order in favour of "JPMA donation account", CASH is not accepted.

Original article: Rs. 2000; for overseas US$80.
Review article: Rs. 2000; for overseas US$80.
Short Report/Short Communication/Special Communication/Case Report:Rs 1500; for Overseas US$45.
Students' Corner: Rs. 1000; for overseas US$30.
Letter to the editor: Rs. 600.00; for overseas US$20.