The article is accepted for publication on the understanding that the work it reports has not been sumitted simutaneously to any other journal, has not been accepted for publication elsewhere and has not already been published. Letter of undertaking: This is to confirm that the original/review article, case report title__________________________ submitted for publication in the Annals of Pakistan Institute of Medical Sciences (APIMS), has not been submitted to, or published previously in any other medical journal. If this is accepted for publcation in the journal, it will not be submitted to any other journal in Pakistan or abroad. We also transfer all the rights of this papers to the Editor Annals of PIMS. The Article contains original work and any false presentation shall be the responsibility of the authors. Name of the authors(s) in the captial letter 1 2 3 4 Signature 1,2,3,4 (This must be signed by all the authors)