Journal of the Pakistan Medical Association is an international biomedical journal from Pakistan. We publish materials of interest to the practitioners and scientists in the broad field of medicine. Articles describing original qualitative, quantitative, human/animal clinical or laboratory studies are considered for publication. All manuscripts should be comprehensible to the general reader and lead to improved decision making in clinical practice, medical education, research and policy. Types of articles include case reports, case series, descriptive and analytical research with clinical trials, short reports, special communications and letter to the editor. Clinical conference abstracts, special issues, articles regarding innovation and those related to research methods and reporting are also published. Secondary research including narrative reviews, systematic reviews, evidence based articles, meta-analysis, practice guidelines will also be considered for publication. From time to time invited articles are published. Manuscripts must be original and not under consideration by another publication.

Journal of the Pakistan Medial Association has agreed to receive and publish manuscripts in accordance with the instructions of 'International Committee of Medical Journal Editors (ICMJE) and the Committee on Publication Ethics (COPE). Details of ICMJE and COPE are available at http://www.icmje.org/ and http://publicationethics.org/

ICJME Statement on Authorship

All persons designated as authors should qualify for authorship, and all those who qualify should be listed. Each author should have participated sufficiently in the work to take public responsibility for appropriate portions of the content. One or more authors should take responsibility for the integrity of the work as a whole, from inception to published article.

Authorship credit should be based only on:

1. Substantial contributions to conception and design, or acquisition of data, or analysis and interpretation of data.
2. Drafting the article or revising it critically for important intellectual content; and
3. Final approval of the version to be published.

Conditions 1, 2, and 3 must all be met.

Acquisition of funding, the collection of data, or general supervision of the research group, by themselves, do not justify authorship.

Authors should provide a description of what each contributed, and editors should publish that information. All others who contributed to the work who are not authors should be named in the acknowledgments, and what they did should be described.

Conflict of interest and funding declaration must be written by the authors at the time of submission.

1. The Journal follows the authorship guidelines of the International Committee of Medical Journal Editors (ICMJE)(http://www.icmje.org/).
2. The Journal follows the standard international definition and description of plagiarism and according to the guidelines provided by the Higher Education Commission of Pakistan (http://www.hec.gov.pk) (http://facpub.stjohns.edu/~roigm/plagiarism/Index.html)
3. The Journal assigns equal responsibility of intellectual integrity of the manuscript to all authors whose names appear on the manuscript/article. When submitting a manuscript, the Journal requires that all authors sign a statement accepting this responsibility.
4. This statement must indicate that no part of the manuscript has been plagiarized.
   
5. Any such material should be made accessible to the Editor and should only be used with referencing according to the guidelines of authorship. This may otherwise form the basis of a redundant publication/duplicate publication/"salami slicing" and appropriate action may be taken by the Editor which may range from rejection of the manuscript to debarment of the authors(s) from further publication in the Journal.
6. Any such material should be made accessible to the Editor and should only be used with referencing according to the guidelines of authorship. This may otherwise form the basis of a redundant publication/duplicate publication/"salami slicing" and appropriate action may be taken by the Editor which may range from rejection of the manuscript to debarment of the authors(s) from further publication in the Journal.
7. It is emphasized that the Journal considers self plagiarism as equally unethical as plagiarism in any other form. If material is to be used from the authors’ previous work, standard referencing guidelines must be followed.
8. All manuscripts submitted to the Journal will be checked for plagiarism. If a manuscript submitted for publication (or a manuscript accepted for publication or an article that has already been published in the Journal) is found to be based on plagiarized material, the Editor will be obliged to write to the author(s) seeking an explanation. The corresponding author will be required to respond with an explanation within 30 days of receiving the letter from the editor.
9. Any such manuscript for review will be held up till the matter is resolved.
10. After receiving the author’s explanation, if considered necessary, the Editor may also send a letter of information to the Head of the Institution or any other relevant authority at the author(s) institution. A similar letter may also be sent to the Higher Education Commission of Pakistan and the Pakistan Medical and Dental Council for information and possible action.
11. In case an acceptable explanation is provided by the author(s), the Editor may recommend appropriate changes after which the review process for the submitted manuscript may commence.
12. In case of failure of author(s) to either respond within the stipulated time, or in case they are unable to provide a suitable explanation, the Editor will convene a meeting of the Plagiarism Committee of the Board of Editors of the Journal to consider further action.
13. Further action will depend upon the nature of the offence and may include rejection of the manuscript from publication along with possible debarment of the author(s) from further publishing in the Journal. The period of debarment will depend upon the nature of the offence and may range from a period of a few months to permanent.
14. Information regarding this action may be published in the forth coming issue of the Journal on a numbered page.
15. In case of confirmation of plagiarism on an already published article, the Editor will be obliged to withdraw the article from the journal website, Medline and Pakmedinet.

Plagiarism, if detected and proved, would be considered a punishable offence. Immediate and unbiased action will be taken by the Plagiarism Committee.

Manuscript submission at Journal of the Pakistan Medical Association is online through electronic mail. Those unable to do so can submit two hard copies of the manuscript and two copies of the figures along with a soft copy (CD) to:

Editor,
JPMA (Journal Of Pakistan Medical Association)
P.M.A. House, Aga Khan III Road,
Karachi- 74400 (Pakistan)
Telephone/Fax :+92 (021) - 32226443
VPTCL : 5418192
E.mail address: jpma_jpma@hotmail.com and editor@jpma.org.pk

Covering letter
All manuscripts should be accompanied by a covering letter from the authors responsible for the manuscript. Mention title, submission type, full names, degrees, affiliated institute, institutional title, e-mail address, corresponding address and phone numbers of all authors. It must explain the importance of the study and the reason it should be considered for publication in Journal of the Pakistan Medical Association. Contributions of all authors should also be declared along with conflict of interest and funding information if applicable. The covering letter should also contain a 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.

Undertaking/Certificate
To start the processing of the article, each manuscript must have a duly signed undertaking/certificate. Undertaking/Certificate is different from a cover letter. Undertaking must mention that the research conducted was original, not submitted to any other publication (abstracts, conference proceeding, journal) and unpublished. The editors of Journal of the Pakistan Medical Association have the right to suggest changes, hold or reject from publication at any stage. The editor also holds the right to retract any article on account of ethical misconduct after the printing of any article. It should also contain the copyright disclosure transferring ownership of the article to Journal of the Pakistan Medical Association.

Please see a sample of the Undertaking/Certificate at the end of this document.

Processing Fee
A non-refundable processing fee of Rs 1000/ will be charged along with the submission of any manuscript through cheque or pay order in favour of "JPMA donation account". No processing fee will be charged for editorials and for submissions from outside Pakistan.


If an article is withdrawn by the authors after acceptance and payment of the publication fees, NO REFUND will be made. This holds good for all authors, within the country and abroad and for all categories of articles.

All corresponding and co-authors must ensure a complete submission process in order to prevent delay in processing and publishing their manuscript. Manuscript will not be considered complete if any of the following is/are missing. Initial submission of any article must include:

1. Covering letter duly signed by all authors.
2. Undertaking/Certificate duly signed by all authors.
3. Complete article with tables, figures and references.
4. Identification of corresponding author with full name, degree, affiliated institute, institutional title, e-mail address, corresponding address and phone numbers.
5. Details of ALL authors including full names, degrees, affiliated institute, institutional title, e-mail address, corresponding address and phone numbers. The journal will only correspond with the assigned corresponding author.
6. Contributions of all authors in accordance with ICMJE guidelines.
7. Declaration of Conflict of interest and funding information
8. Copy of ethical permission letter from concerned institution where research has been conducted.
9. Processing Fee

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. Each manuscript will be check for technical, epidemiological, statistical, and ethical and language corrections.
All parts of accepted manuscripts are subject to editing for scientific accuracy and clarity by the office of the Editor. The editorial board of Journal of the Pakistan Medical Association holds the right to a final decision of accepting or rejecting any article from publication in the journal, at all stages including the editorial review.

Submission Format according to article type
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.

General Requirements
Manuscript must be written in ‘British English’. Non-native English speakers must seek the assistance of experienced, English-speaking medical editors if in doubt. Taking feedback from your colleagues also makes the manuscript writing more productive, versatile and simple for the readers.
• Type the manuscript on A4 size (8.5x11 inches or 21.6x27 cm) white bond paper, with margins of at least 1.5 inches (4 cm).
• Type on one side of the paper, double spacing every page.
• Begin each 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 with legends.
• Number pages consecutively in the upper right-hand corner of each page, beginning with the title page. Type the page number.
• Present decimal figures up to 2 decimals only. e.g. 0.07 is correct instead of 0.071
• Sentences should be properly structured instead of giving brackets within a sentence. e.g. The study participants (women of age group 25-30 years) were approached for the interviews. The correct way is ‘The study participants included women of age group 25-30 years. They were approached for the interviews.’

Special Instructions
The editorial board of Journal of the Pakistan Medical Association appreciates the efforts of The EQUATOR(Enhancing the QUAlity and Transparency Of health Research) Network for promoting good reporting of research. It has played a pivotal role in development, dissemination and implementation of reporting guidelines throughout the world. To find details visit http://www.equator-network.org/
Reporting of each article should be according to the scientific reporting guidelines provided by the EQUATOR Network. Separate guidelines are available for each study design and topic under study. We are thankful to the office bearers and contributors of the EQUATOR Network to allow Journal of the Pakistan Medical Association to be the first journal from Pakistan to adapt these reporting guidelines. A comprehensive list of reporting guidelines is available at http://www.equator-network.org/resource-centre/library-of-health-research-reporting/
Please check the summary of the reporting guidelines according to the most commonly used study design method at the end of this document.

A. Title Page

The title page of the manuscript should include:

• Concise and informative title (less than 14 words)
• Complete by line, with first, middle and last names of each author.
• Complete affiliation for each author, with the name of department (s) and institution (s) to which the work should be attributed. Name, address and telephone number and email address (necessary) of one author responsible for correspondence about the manuscript.
• Clearly identify the corresponding author.
• Source(s) of support in the form of grants equipment, drugs, or all of these.
• Disclaimer, if any.
• Word count of abstract with 3-5 MeSH words
• Word count of main article, excluding abstract and references.

B. Abstracts

It should briefly describe the problem being addressed in the study, how the study was performed, the salient result and what the authors conclude from the results. Structured of unstructured abstract should be in accordance to the article type. 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 (case report, short communication, special communication and review article) is required. The structured abstract should consist of four paragraphs, under the headings: Objective, Methods, Results and Conclusion. Results should mention key frequencies, percentages and findings. Abstracts should be followed by 3-5 MeSH words. Details available from the Medical Subject Headings (MeSH) list of index medicus. For assistance see: http://www.ncbi.nlm.nih.gov/mesh

C. Introduction

Global, regional and local reports on the topic being mentioned in the article should, where appropriate, be included. State the purpose of the study. Give only strictly pertinent references. Explain your hypothesis, why you think this research was required and what benefit will be derived from your objectives. Clearly mention the objective(s) of the study in this section without adding any sub-heading.

D. Methods

Mention all the components of methodology here, including study design, describe your selection of the observational or experimental subjects (patients or laboratory animals, including controls).Mention study setting, duration, sampling method, sample size calculations with reference and follow-up period. Mention the inclusion and exclusion criteria, if applicable without adding any headings.
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. 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.
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.

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 and with the latest (2008) version of Helsinki Declaration of 1975. Do not use patients' names, initials, or hospital numbers, in text and illustrative material.
When reporting experiments on animals, indicate whether the institutions or a national research council’s guide for or any national law on the care and use of laboratory animals was followed.
Please, document that the study was approved by the ERB (Ethical Review Board) of the concerned University / Institution. You may be required to provide a certificate from the ERB, with data and signature of all authors involved in the study. Also, informed consent of the subjects studied should be clearly stated.
If the institution does not have an Ethical Review Committee then the Instituion's Approval from the concerned department may be submitted.
These documents are required for all categories of articles.

Statistics
Methods section is incomplete without mention of the statistical tests applied. 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 from 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.

E. 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. Frequencies and percentages both should be mentioned. e.g. There were 18(2%) men. Exact p values should be reported. Mean should be with SDs. Medians should be with IQR.

F. 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.

G .Conclusion

It should be based on the objective and principal findings. False ambiguous conclusion and speculations should be avoided.

H. Acknowledgements

Persons who have contributed intellectually to the research 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.

I. References

Vancouver style is essential for publication in Journal of Pakistan Medical Association. References should be cited in consecutive numerical order at first mentioned in the text and designated by the reference number in superscript. 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. Hoshimoto-Iwamoto M, Koike A, Nagayama O, Tajima A, Uejima T, Adachi H, et al. Determination of the VE/VCO2 slope from a constant work rate Exercise test in Cardiac patients. J Physiol Sci 2008; 58: 291-5.
Dalby MA. Epilepsy and three per second spike and wave rhythms: a clinical electroencephalographic and prognostic analysis of 346 patients. Acta Neurol Scand 1969; suppl 40: 1-30.
For books and book chapters, follow the examples below:
Drury I. Activation of seizures by hyperventilation. In: Luders HO, Noachtars, eds. Epileptic seizures: pathophysiology and clinical semiology, Philadelphia: Churchill & Livingstone, 2000; pp 575-9.

For newspaper articles:
Carynrabin R. When the Surgeon is infected, how safe is the surgery? New York Times 2007 July 3. Journal article in electronic:
Jonas J, Vignal JP, Baumann C, Anxionnat JF, Muresan M, Vespignani H, et al. Effect of hyperventilation on seizure activation: potentiation by antiepileptic drug tapering. J Neurol Neurosurg Psychiatry. Published Online First: 20 June 2010 doi:10.1136/jnnp.2009.200329.

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]. Available from: 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 be used.

Species Names
Species should be written in italics. e.g. P.vivax

M. 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/legends should be descriptive, brief and mentioned on top of the table. 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. If abbreviations are used in table give full text at the bottom of the table.

J. Figures

Figures and pictures 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 3.5x5 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.

K. Legends for Illustrations

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.

Submission of manuscript will considered complete if the following is attached with the submitting article. Sequence of sections of the article must be strictly followed as below:

1. Title page with title, authors' names and complete affiliations; corresponding author, complete address, telephone number and email address (mandatory), author for reprint requests and complete address of ALL authors.
2. Abstract
3. MeSH words
4. Introduction
5. Methodology
6. Results
7. Discussion
8. Conclusion
9. Acknowledgements
10. References in consecutive numerical order. Reference list typed double space.
11. Figures and Tables in consecutive numerical order. All illustrations must be inserted in the text as numbers, only. No illustration should be arranged in between the article sections.
12. Legends for all figures typed double spaced, correctly numbered. If needed, written permission from the publisher to reprint previously published figures and tables, two sets of unmounted glossy Figures (no smaller than 3-1/2x5 inches and not larger than 8x10 inches) and consent forms for patient photographs are also required. Additional files to assist the editorial board in accepting your article can also be attached.

I, ....... (corresponding author) and my below mentioned colleagues are submitting our original research titled, ............. to the Journal of the Pakistan Medical Association for publication.

We agree that upon acceptance by Journal of the Pakistan Medical Association, all copyright ownership for the article is transferred to The Pakistan Medical Association. We, the undersigned 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.

The editors of Journal of the Pakistan Medical Association have the right to suggest changes, hold or reject from publication at any stage. The editor also holds the right to retract any article on account of ethical misconduct after the printing of any article.

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. This statement must be signed by all the major co-authors.

Yours’ sincerely,

(Names and signatures and date of ALL authors)

Reporting Guidelines According to the Most Commonly Used Study Design Method