The Institute of Medicine (IOM) was established
in 1972 under Tribhuvan University. Within a decade of its establishment,
a total of 12 campuses have been established under the institute,
all scattered throughout the country. Initially, numerous programs
were undertaken to generate competent middle level health workers
initially which included; ANM, CMA, Proficiency Certificate Course
in General Medicine, Pharmacy, Radiology, Physiotherapy, Nursing,
Health Laboratory and Traditional Medicine. By 1977 it had, at
graduate level, a 2-year Bachelor of Nursing Program in Community
Nursing, Pediatric Nursing and Adult Nursing and in 1978, a community-oriented
integrated MBBS program was started with an intake of 22 students.
At post-graduate level, a three year Postgraduate Generalist (Family
Physician) Training in 1982 and one-year Postgraduate Diploma
in Anaesthesiology in 1984 were started with support from the
University of Calgary, Canada. Today the IOM is running 49 different
programs from proficiency certificate level to the highest postgraduate
degree in medicine, public health, paramedical, nursing and traditional
medicine (ayurved Science) through 17 campuses scattered all over
the country. Recently, in 2008 MCH program in various subspecialty
in Surgery was initiated with the aim to provide superspeciality
training in the country and similar programs are planned in other
faculties in the near future.
A three hundred-bedded Tribhuvan University Teaching Hospital
was completed in 1984 with support from JICA which in itself was
a landmark in the health sector of the country. Another 100 beds
were added in 1993 and now, Tribhuvan University Teaching Hospital
has 482 beds and is one of the biggest hospitals in country at
this time, to provide tertiary health service to the Nepalese
people. It is also the only hospital to provide services in largest
number of medical specialties (22 medical specialties). This is
an institutional hospital being used for the teaching/learning
activities of different programs run by IOM and is also involved
Journal of institute of medicine (JIOM) is a multispecialty journal
carrying the aspirations of all those affiliated to the Institute
of medicine. It is a scientific medical journal in English and
publishes papers on health and medical issues. It was established
in 1979 and the first Chief Editor was Prof Gopal Acharya. First
year of publication of the electronic version was on 1998. The
online version is available at http://www.jiom.com.np/home.htm.
As IOM has numerous
campuses, institutes and colleges affiliated to it and runs
a wide array of programs, it is rich in myriads of academic
activities including research. The main objective of the JIOM
is to serve as a portal by documenting the research activities.
JIOM encourages scientific paper writing and dissemination of
this information. We are of strong belief that each research
conducted and the results henceforth obtained have strong implication
for the community. In this regards, JIOM aims to be the centerpiece
in the whole process of dispersion of information and knowledge.
The journal accepts scientific articles from various faculties
and students of the Institute of Medicine and its affiliated
institutes or from any other institutes, if the subject matter
addresses important issues. Scientific articles related to all
the disciplines of medicine, public health or health care management
and those articles having impact on health in any form are accepted,
but the editorial board reserves the right to deny publication
if it deems so. Preference is given to original articles with
Original articles, review
articles, articles on P.H.C., medical education and manpower
training and case reports are welcome
- The articles will be accepted for
publication only after clear indication by the author that
the manuscript has not been submitted elsewhere for publication.
- We have a policy to discourage articles
that have conflict of interest in terms of financial assistance
- Data and references in an article
are the sole responsibility of the author and any attempt
to falsify them will be taken as an offence
- All contributions are judged by the
criteria of originality and scientific content, and preference
will be given to original research articles.
- The manuscripts are subjected to peer
- The editors reserve the right of refusing
to publish articles that have been submitted.
- The opinions expressed in the articles
are the author’s own and do not necessarily reflect the views
of the publisher or the editorial board.
It is assumed that the
author understands that by submitting the article to the journal;
the article has not been published in any other journal in the
past and also has not been submitted simultaneously to other
journals. All the moral responsibility of such act lies with
the main author and the corresponding author. Such acts are
regarded as an offence. If the author wishes to withdraw a manuscript,
a written letter signed by all the coauthors, addressed to the
‘Editor in Chief’ should be submitted to the ‘Editorial Office’.
Manuscripts must be written in clear, concise English and submitted
to the ‘Editorial Office’ of JIOM. Digital submission in the
form of CD or through email is required according to the guidelines
issued by the journal. The manuscript should also include a
Forwarding, Authorship and Declaration letter duly signed. Sample
letters can be downloaded from the website of the journal or
requested by email. Corresponding authors should clearly mention
their address along with their email address and phone number.
Journal of institute of medicine (JIOM)
Institute of Medicine
Office of the Dean
Maharajgunj, Kathmandu, Nepal.
The manuscript will
be submitted for peer review after the editors review it for
content and basic format. Manuscripts lacking originality, serious
scientific and technical flaws or significant message can be
rejected before it is sent for peer review. An article has to
be written in such a way that it complies with the format of
the journal and authors can be asked for resubmission after
The review process will take around 2 to 6 months and there
might be further delays during the holiday season. Reviewers
are selected by the editors and information regarding authors
and institution related to the article are withheld from them.
Original articles are sent to two reviewers and case reports
to a single reviewer. In case of conflict, they are sent to
a third reviewer before being rejected or accepted. Authors
are informed regarding reviewers comments and advised for revisions
to the article accordingly. If there is any undue delay in response,
the article will be taken as a resubmission and the article
will have to undergo a whole new review process.
The Editorial board reserves the final right to accept articles
JIOM is published three
times a year on April, August and December. The printed issues
can be subscribed from the Editorial Office and the rates are
mentioned below. JIOM grants permission to read, download, copy
and distribute articles published for free provided they are
done in the manner in which they were published and without
any modifications. Authors are also not charged for submission,
processing or publication of articles. The digital form can
be downloaded from the website conditionally but free of cost.
Authors are entitled to a free copy of the journal in which
their articles are published and it has to be collected from
the editorial office within two months of publication of the
issue. Additional copies have to be bought and are subject to
While every effort is made by the Editorial Team and the press
to avoid inaccurate or misleading information appearing in JIOM,
data within the individual articles and advertisements are the
responsibility of the authors or advertisers concerned. The
JIOM editorial team and the press accept no liability whatsoever
for the consequences of any such inaccurate or misleading data,
opinion or statement.
Correspondence regarding subscription should be addressed to
the editorial office. Subscription rates can be revised at any
time without prior notice. Payment for the subscription is to
be sent in the form of bank draft or crossed-cheques in favour
Maharajgunj, Kathmandu, Nepal.
P.O. Box. 1524,
Rates are as follows (excluding postage rates):
Rates are subject to change without prior notice
Rates Annual Per copy
Nepal N.Rs. 300.00 150.00
SAARC countries, Burma N.Rs. 300.00 150.00
(the equivalent of) US$ 50.00 20.00
JIOM publishes advertisements submitted for a fee. Information
provided in the advertisement is not endorsed by the journal.
The editorial office can be contacted for advertisement details
regarding rates, terms and conditions.
Prof. Pradeep Vaidya
Prof. K.K Kafle
Prof. Bimal Sinha
Prof. C.K Gurung
Prof. Ashma Rana
Dr. Ananda B Joshi
Dr. Sarala Joshi
Dr. Prem Khadka
Dr. Ishwar Lohani
Dr. Bikal Ghimire
Prof. A. Sayami
Prof. T.P. Thapa
Dr. R.P. Upreti
Prof. M.P. Khakurel
Prof. Sarala Shrestha
Prof. P.R. Sharma
Mr. Kali Prasad Rosyara
Instructions for Authors
Title page of the manuscript should contain:
1. Type of manuscript (Original article, Reviews and Case
2. Title of the article.
3. The name(s) of the author(s): family name(s) followed
by first name(s).
4. The name(s) of the department(s) or institution(s) affiliated
to the author(s). The affiliation should comprise the department,
institution, city and nation from which the work originated.
5. The name and full mailing address (including telephone,
fax numbers and e-mail address) of the “Corresponding author”.
6. Total number of pages, photographs and word counts separately
for abstract and for the text (excluding references).
7. Sources of financial support in the form of grants, equipments,
drugs, etc. if any.
8. The running head should be of maximum 40 characters,
including word spaces and should indicate major features
of the article.
Conflict of Interest: No/Yes [if yes mention]
To prevent the information on potential conflict of interest
for authors from being overlooked or misplaced, it is necessary
for that information to be part of the manuscript. It should
therefore also be included on a separate page or on pages
immediately following the title page. JIOM reserves the
right to send information on conflict of interest to reviewers.
This should be not more than 200 words on the second page
of the manuscript and be presented in a structured format.
Introduction, Methods, Results and Conclusions.
The abstract should provide the context or background for
the study and should state the a) study’s purposes b) basic
procedures (selection of study subjects or laboratory animals,
observational and analytical methods) c) main findings (giving
specific effect sizes and their statistical significance,
if possible), and d) principal conclusions. It should emphasize
new and important aspects of the study or observations.
Because abstracts are the only substantive portion of the
article indexed in JIOM electronic databases, and the only
portion many readers read, authors need to be careful that
abstracts reflect the content of the article accurately.
Unfortunately, many abstracts disagree with the text of
We request you to provide, and identify as such, 3 to 10
keywords or short phrases that capture the main topics of
the article. These will assist indexers in cross-indexing
the article and may be published with the abstract. Terms
from the Medical Subject Headings (MeSH) list of Index Medicus
should be used; if suitable MeSH terms are not yet available
for recently introduced terms, present terms may be used.
The keywords should be arranged in alphabetical order being
separated by commas and a space with the first keyword initially
Provide a context
or background for the study (i.e., the nature of the problem
and its significance). State the specific purpose or research
objective of, or hypothesis tested by, the study or observation;
the research objective is often more sharply focused when
stated as a question. Both the main and secondary objectives
should be made clear, and any pre-specified subgroup analyses
should be described. Give only strictly pertinent references
and do not include data or conclusions from the work being
The method section
should contain: a) Study design b) Duration of study c) Place
of study d) Ethical approval e) Patient consent e) Inclusion
and exclusion criteria f) Sampling g) Statistical analysis
and h) Software used.
The Methods section should include only information that was
available at the time the plan or protocol for the study was
written; all information obtained during the conduct of the
study belongs to the Results section.
Selection and Description of Participants: Describe your selection
of the observational or experimental participants (patients
or laboratory animals, including controls) clearly, including
eligibility and exclusion criteria and a description of the
source population. Because the relevance of such variables
as age and sex to the object of research is not always clear,
authors should explain their use when they are included in
a study report; for example, authors should explain why only
subjects of certain ages were included or why women were excluded.
The guiding principle should be clear about how and why a
study was done in a particular way. When authors use variables
such as race or ethnicity, they should define how they measured
the variables and justify their relevance.
Technical information: Identify the methods, apparatus (give
the manufacturer’s name and address in parentheses), and procedures
in sufficient detail to allow other workers to reproduce the
results. Give references to established methods, including
statistical methods (see below); 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.
and animal rights
When reporting research on human beings, the authors must
include an assurance that the work was approved by a medical
ethics committee and that the subjects had given in their
informed consent to participate in the research and the study
was in accordance to the Helsinki declaration of 1975 as revised
in 2000 (available at http://www.wma.net/e/policy/17-c_e.html).
Do not use patient’s names, initials, or hospital numbers,
especially in 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
were followed. Evidence for approval by a local ethics committee
(for both human as well as animal studies) must be supplied
by the authors on demand. Animal experimental procedures should
be as humane as possible and the details of the anesthetics
and analgesics used should be clearly stated. The ethical
standards of experiments must be in accordance with the guidelines
provided by the ‘Committee for the purpose of control and
supervision on experiments on animals’ d CPCSEA. (available
at envfor.nic.in/divisions/awd/cpcsea_laboratory.pdf -)
The journal will not consider any paper which is ethically
unacceptable. A statement on ethics committee permission and
ethical practices must be included in all research articles
under the materials and methods section.
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 measurement
error or uncertainty (such as confidence intervals). Avoid
relying solely on statistical hypothesis testing, such as
the use of P values, which fails to convey important information
about effect size. References for the design of the study
and statistical methods should be to standard works when possible
(with pages stated). Define statistical terms, abbreviations,
and most symbols. Specify the computer software used.
Present your results in logical sequence in the text, tables,
and illustrations, giving the main or most important findings
first. Do not repeat in the text all the data in the tables
or illustrations; emphasize or summarize only important observations.
Extra or supplementary materials and technical detail can
be placed in an appendix where it will be accessible but will
not interrupt the flow of the text; alternatively, it can
be published only in the electronic version of the journal.
When data are summarized in the Results section, give numeric
results not only as derivatives (for example, percentages)
but also as the absolute numbers from which the derivatives
were calculated, and 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,”
Where scientifically appropriate, analyses of the data by
variables such as age and sex should be included.
Emphasize the new and important aspects of the study and the
conclusions that follow from them. Do not repeat in detail
data or other material given in the Introduction or the Results
section. For experimental studies, it is useful to begin the
discussion by summarizing briefly the main findings, then
explore possible mechanisms or explanations for these findings,
compare and contrast the results with other relevant studies,
state the limitations of the study, and explore the implications
of the findings for future research and for clinical practice.
Link the conclusions with the goals of the study but avoid
unqualified statements and conclusions not adequately supported
by the data. It should be short and to the point rather than
a summary of the article. In particular, authors should avoid
making statements on economic benefits and costs unless their
manuscript includes the appropriate economic data and analyses.
Avoid claiming priority and alluding to work that has not
been completed. State new hypotheses when warranted, but clearly
label them as such.
References should be typed double spaced in a separate section
at the end of the manuscript and numbered consecutively in
the order in which they are cited in the text. Published articles
and those in press (state the journal which has accepted them
and enclose a copy of manuscript) may be included. Cite in
the text by the appropriate Arabic numbers in superscript.
Include the last names and initials of all authors [multiple
authors: list up to the first 6 authors followed by et al.],
title of article, name of publications, year published, volume
number, Issue number and inclusive pages. The style and punctuation
of the references should confirm the following examples (i.e.,
Vancouver Style): Please refer to the guidelines at
http://www.icmje.org or http://www.nlm.nih.gov/bsd/uniform_requirements.html
Russell FD, Coppell AL, Davenport AP. In vitro enzymatic processing
of radiolabelled big ET-1 in human kidney as a food ingredient.
Biochem Pharmacol. 1998 Mar 1;55(5):697-701.
Explanation of above citation:
Russell FD, Coppell
AL, Davenport AP. In vitro enzymatic processing of radiolabelled
big ET-1 in human kidney as a food ingredient. Biochem Pharmacol
1998 Mar 1;55(5):
Getzen TE. Health
economics: fundamentals of funds. New York: John Wiley &
Explanation of above citation:
Getzen TE. Health
economics: fundamentals and flow of funds. New York: John
Wiley & Sons; 1997.
- Porter RJ, Meldrum BS. Antiepileptic
dugs. In: Katzung BG, editor. Basic and clinical pharmacology.
6th ed. Norwalk (CN): Appleton and Lange; 1995. p. 361-80.
Tables should be numbered (with Arabic numerals) and each
table should be typed on a separate sheet of paper. Tables
should be self-explanatory and include a brief descriptive
title. Footnotes to tables, indicated by lower case letters
are accepted, but they should not include extensive experimental
Tables capture information concisely, and display it efficiently;
they also provide information at any desired level of detail
and precision. Including data in tables rather than text frequently
makes it possible to reduce the length of the text.
Type or print each table with double spacing on a separate
sheet of paper. Number tables consecutively in the order of
their first citation in the text and supply a brief title
for each. Do not use internal horizontal or vertical lines.
Give each column a short or abbreviated heading. Authors should
place explanatory matter in footnotes, not in the heading.
Explain in footnotes all nonstandard abbreviations. For footnotes
use the following symbols, in sequence:
Identify statistical measures of variations, such as standard
deviation and standard error of the mean.
Be sure that each table is cited in the text.
If you use data from another published or unpublished source,
obtain permission and acknowledge them fully.
Illustrations: Graphs, charts, diagrams or pen drawings must
be drawn by professional hands in Indian ink (black) on white
drawing paper. In case of x-ray, miniature photo prints should
be supplied. Photographs should be supplied in high quality
glossy paper not larger than 203 mm x 254 mm (8" x 10").
In case of microphotograph, stains used and magnification
should be mentioned. Each illustration should bear on its
back the figure number and an arrow indicating the top. All
illustrations should be black and white and should be submitted
in triplicate with suitable legends. We accept electronic
version which should be resolution of 300 dpi, and the dimension
of 640 X 480 to 800 X 600 dimension & picture format should
be JPEG (*.jpg, *.jpeg) or TIFF (*.tif, *.tiff). Pictures
will be published in B/W free of charge. But, if you want
to publish your picture in color, please contact the editorial
board for the cost and payment procedure.
For x-ray films, scans, and other diagnostic images, as well
as pictures of pathology specimens or photomicrographs, send
sharp, glossy, black-and-white or color photographic prints,
usually 127 mm x 173 mm (5" x 7"). Letters, numbers
and symbols on figures should therefore be clear and even
throughout, and of sufficient size that when reduced for publication
each item will still be legible. Figures should be made as
self-explanatory as possible, since many will be used directly
in slide presentations. Titles and detailed explanations belong
in the legends, however, not on the illustrations themselves.
Photomicrographs should have internal scale markers. Symbols,
arrows, or letters used in photomicrographs should contrast
with the background.
If photographs of people are used, either the subjects must
not be identifiable or their pictures must be accompanied
by written permission to use the photograph. Whenever possible,
permission for publication should be obtained.
Figures should be numbered consecutively according to the
order in which they have been first cited in the text. If
a figure has been published, acknowledge the original source
and submit written permission from the copyright holder to
reproduce the material. Permission is required irrespective
of authorship or publisher except for documents in the public
For illustrations in color, ascertain whether the journal
requires color negatives, positive transparencies, or color
prints. Accompanying drawings marked to indicate the region
to be reproduced might be useful to the editor.
Authors should consult the journal about requirements for
figures submitted in electronic formats.
Type or print out legends for illustrations using double spacing,
starting on a separate page, with Arabic numerals corresponding
to the illustrations. When symbols, arrows, numbers, or letters
are used to identify parts of the illustrations, identify
and explain each one clearly in the legend. Explain the internal
scale and identify the method of staining in photomicrographs.
Units of Measurement
Use the decimal point, not a comma. e.g. 5.7. Use a space
not a comma after thousands and multiples thereof, e.g. 10
000. Use SI units (International System of Units) except for
the measurement of blood pressure (mm Hg) and temperature
(degree Celsius). Where measurements were made in non SI units,
give the actual values and units with SI equivalents inserted
in parenthesis at appropriate points.
Use only standard abbreviations; the use of non-standard abbreviations
can be extremely confusing to readers. Avoid abbreviations
in the title. The full term for which an abbreviation stands
should precede its first use in the text unless it is a standard
unit of measurement. Do not use abbreviations like @, &
in the text.
Final checklists before you submit your revised article for
the possible publication in the JIOM:
1. Forwarding letter
o If you have submitted the above mentioned documents (1,
2, 3 and 4) when you first submitted your article, then you
don’t need to re-submit it but if there is change in the authorship
or related things, then you have to re-submit it.
o Specific instructions for related HEADINGS have been mentioned
in the sample file for “Manuscript”.
o Please read our published article to get an idea about the
manuscript you submit from our website www.jnma.com.np
for article presentation and format
– Margins 2.5 cm from all four sides
– Title page should contain all the desired information
– Running title should be provided (not more than 40 characters)
– Abstract page should contain the full title of the manuscript
– Abstract should be provided (word limit: 150 words for case
reports and 200 words for original articles)
– Structured abstract should be provided for an original article
– Key words should be provided – arrange them in alphabetical
order (three or more)
– Headings in title case (not ALL CAPITALS, not underlined)
– References cited in superscript in the text without brackets
after with/without comma (,) or full stop (.)
– References according to the journal’s instructions – abide
by the rules of Citation Medicine.
– Uniformity in the language
– Abbreviations spelt out in full for the first time
– Numerals from 1 to 9 spelt out
– Numerals at the beginning of the sentence spelt out
– Use abbreviated form only after using its full form when
it first appears in the text except abstract.
– No repetition of data in tables/graphs and in text
– Actual numbers from which graphs are drawn to be provided
– Figures necessary and of good quality (Black and white)
– Table and figure numbers in Arabic letters (not Roman)
– Labels pasted on back of the photographs (no names written)
– Figure legends provided (not more than 40 words)
– Patients’ privacy maintained (if not, written permission
– Credit note for borrowed figures/tables provided
1. Uniform requirements for manuscripts submitted to biomedical
manuscript preparation and submission: preparing a manuscript
for submission to a biomedical journal. [Online]. 2009 [cited
2010 Jan 15]; Available from: URL:http://www.icmje.org/manuscript_1prepare.html.
2. Journal of Nepal Medical Association. J Nepal Med Assoc.
2009 Apr-Jun; 48(174).