4.1 Title

The title of the paper should not only be attractive, but informative to describe the submitted research in the most comprehensive way. It is the only piece of information that other researchers will look into while searching a database or a search engine and consequently, should include all relevant aspects of the study such as Background of the disease/condition being analysed, methods/techniques undertaken to gauge the study, patients or population being evaluated and with an idea of category of described study design (e.g. retrospective or prospective, observational cohort or randomised, adult, paediatric or mixed population).

4.2 Keywords

Keywords, also called search terms, are specific words or short phrases that characterize the main ideas in your research topic. Keywords are important to navigate search engines or databases to get results about the article one plans to submit. The most widely used keyword thesaurus is the MeSH (Medical Subject Headings) controlled by the National Library of Medicine (NLM), for indexing, cataloguing, and searching of biomedical information.⁷

4.3 Abstract

An abstract is one of the most crucial components of the submitted paper and is the foremost section read by both the editor and reviewers. Hence, it must be prepared with great dexterity to showcase the important findings of your research. However, it is suggested, an abstract should be written at the end when rest of the article is almost ready for review. It is critical to ensure that there are no inconsistencies in the abstract from the study's aims and objectives, results and conclusion.

The abstract should provide a comprehensive view of the article in a concise and factual form. According to the journal guidelines, it may have to be prepared in an Unstructured or structured format. Unstructured abstracts are usually appropriate for narrative reviews or case reports.⁸ However, the abstract for a original or research article is mostly structured with precise word limit of (250–300 words). The aim/hypothesis/purpose of the study, methodology, results, and conclusions highlighting the most salient finding of the study/review is expected to be stated briefly in the abstract. An abstract should have no references; keywords and use universally approved abbreviations, which can be used later in the text.

4.4 The main ingredients of the manuscript

Introduction: The introduction should state about provide some background knowledge about work, identify the goals and purpose of the research. It should be limited to 4 to 5 paragraphs in total with not more than 10 or 15 references for the bibliography. The opening paragraph should provide a broad overview of the topic of concern before moving on to a discussion of the specific component of the problem that the authors are trying to report, or they may be able to describe the broader issue that their research is seeking to address. Introduction also involves highlighting what is already known about the subject of interest in the published literature. In fact, Introduction section identifying the ‘Gap in Knowledge’ and the pathway the submitted article is trying to bridge. In the final paragraph, the primary and secondary aims of the study are emphasized, underscoring any proposed hypothesis. It may be prudent to accentuate the benefits of the outcome/s of the study. Search strategy, Research planning and manuscript preparation can help to overcome the most typical causes for manuscript rejection.⁹ A widely used Search strategy to answer a research question is framed in terms of PICO (Patient/population/problem, Intervention, Control/comparative, and Outcome) format.

Material and Methods: The methodology must provide the study settings and design, as well as operational definitions. A typical template for an original article includes study design, statement of Ethics (Institutional Review Board (IRB)or Ethic committee authentication), Inclusion and Exclusion criteria, Data collection, Statistical methods and comment about the funding of study. Ethics and permission of scientific/IRB approval statements before the start of study are mandatory documents and should be uploaded at the time of submission. Biostatistics is an essential element strengthening the analysis and underlines the significance of finding/s (e.g. p value) of the study. It usually forms the final segment of the methodology section.

Results: The results of the study are described in a descriptive and clear manner without the additions of citations. The Result should be focused on answering the questions posed in the introduction and study aims. Population demographics, characteristics of included cohort of patients are introduced in the initial part of the Results section. It is often useful to incorporate sequentially summarised findings in Tables, Figures/Images format and to mention the key messages from these in the text. Too many Figures and Tables can cause paper to be rejected outright. Tables and figures should not be out of context, or excessively simple or complex. It should include clear comparative statistics on the control and cohort groups, as well as appropriate p values to emphasize statistically significant findings. Copying and pasting legends into the result section is a typical mistake by authors; that should be avoided. Duplication of findings in the text and Tables/Figures is to be avoided. If the authors believe there is too much data to be submitted with the manuscript, a ‘Supplementary file’ can be created and submitted with the publication for peer-review. The Figure/s should be in a standard format as per journal guidelines, with explanatory legends and acceptable resolution. It is necessary for authors to be clear and accurate about measurements amongst the study groups. Results should follow the sequence of events according to aims of the study. It is a common error to write results that is different from the study's aims and or new keywords or variables in the result without describing them in a methodology section.

Discussion: The discussion should be consistent with the aims and conclusions of the study. It should be concise, properly cited, and free of tense inconsistencies. The opening paragraph of the discussion is crucial, where the authors highlight the main summary of their study findings, summarise results of previous studies and accentuate why their study is important. It should also include the take-home message.

In the subsequent paragraphs, the study findings are compared, contrasted and debated against findings of previously published reports on the topic in the literature. It is best not to over-interpret your own findings e.g., in a retrospective study, you can only prove association, not the causation. Similarly, it is advisable to mention study's strengths and limitations to drive home the message and challenges associated with the conduct of the study.

Conclusion: In conclusion section, the authors are expected to write concise and salient findings of their work. It is recommended not to comment on aspects authors have not investigated in their study.4)Language: The need of clear, understandable medical text is obligatory. Minor inadequacies in language and grammar can be overlooked by the editorial office and often correctible after peer-review process in a revised paper; but a poorly written paper with numerous typos, careless writing, consistent, repeated disregard of ethical guidelines is likely to be rejected, mercilessly. The usual reasons of a paper rejection are poor English grammar, too many words (in a sentence), jumpy tenses, and repeated words. The authors should follow an order of write, rewrite, read, review, and revise before submission. It is advisable to send the draft article to be reviewed by all co-authors for scientific content, spelling check, grammar, sentence structure and punctuations before submission. The submitted manuscript is to be written in a medical language with explicit terminology. Medical writing and manuscript preparation can be supported with the use of various free or paid software programmes as well as English editing services such as Grammarly, Quill Bot, etc.¹⁰ Peer academic mentorship and assistance from an native English speaker can strengthen effective writing. Finally, the manuscript is properly formatted to give uniformity in terms of font style and size, indent and spacing, heading style and paragraphs.5)Plagiarism check: It is to be ensured that the paper does not duplicate existing literature (not more than six words in continuity). Before submission, it is advisable to check the Similarity score/plagiarism score with the application of reliable software such as iThenticate™/Turnitin™ and rectify the deficiencies. A paper with a high Similarity score (e.g. >20%) is unlikely to be accepted for review in any standard journal.6)Submission Process: Traditionally nowadays, all articles are submitted through a online manuscript submission portal. Disclose statements including CReDIT author contributions, Conflict of Interest statements, Informed consent (Patient/Guardian) if applicable, Acknowledgement (if any) form a mandatory part of the submission process. International Committee of Medical Journal Editors (ICMJIE) Recommendations for the Conduct, Reporting, Editing, and Publication of Scholarly work in Medical Journals are universally followed in the publication process.¹¹7)Cover Letter: Last but not the least, the authors must write a strong and well-structured cover letter, highlighting their Research. It helps the Editors to understand the uniqueness of their paper and encourage them to send it for further review.¹² It is the only opportunity that the authors have to communicate with the Editors directly and hence it should always be availed judiciously!!8)Peer review: Peer review is the foundation on which published medical literature is established. All submitted articles following the initial editorial process undergo peer review process to establish and affirm the validity of article or study. Though the peer review process may take some time to fruition, reviewer comments often strengthen the content of the manuscript and integral for a high-quality publication.¹³ The Peer-review is enshrined in ethical principles and is expected to be fair, transparent and timely process to avoid unnecessary delay in the ensuing decision on a manuscript.¹⁴9)Revision of a manuscript: It is an inherent follow-up sent to the authors following Peer-reviewed comments to address their concerns or clarify any inconsistencies in the original manuscript. The corresponding author usually receives this notification and an appropriate revision is expected over a specified time period. The revised manuscript has to be accompanied by ‘Response to Reviewer’ document seeking explanation to reviewer's queries or an rebuttal to their comments. If approved, the revision documents gets accepted for publication.10)Proof Reading and Citation of the Manuscript: By this time, the authors have nearly finished their journey towards a citable publication. The ‘Proof Reading’ stage is the chance for final corrections specifically of authors name, title, ORCID Identification and Institution/s where the study was conducted. It is not a phase for whole scale changes in the manuscript.11)Rejection: A submitted manuscript can be rejected for a variety of reasons (Table 3). It happens to budding authors or even the experienced authors. Though the initial response to rejection of a submitted manuscript may be despondency or even anger, it may be prudent to gather one's thoughts as to the best step forward. The reasons for rejection apart from the ones described above include:a)The submitted article may not suit the Aims and Scope of the journal or not suitable for the readershipb)The journal may be receiving more submissions than they can possibly publishc)Rejection may be due to submission of incomplete data or the study may have been commented to be premature.

The amount of feedback provided to authors following rejection differs with different journals.

If the authors have a firm belief in their work, following steps can be taken:i.Read the Peer-review or the Editor comments about strengths and weaknesses found in the article. Try to correct them. Feedback from the rejection is a good subject to improve your submission for the second time.ii.You can try to resubmit with more robust data or larger study population or statistical analysis if these were some of the comments made by the Reviewers and along with different cover letter to the same journal.iii.More often, a new journal needs to be found. Do a search again for another Matching journal by reading Aims and Scope of the journal.iv.The second journal, reorganise your cover letter to the second journal with the corrections undertaken to strengthen your manuscript.

Most articles initially rejected, ultimately find a second or third home. The key is perseverance, having confidence in the study aims and robust data or evidence to support it presented in a effective way.12.Review Speed: The “Review Speed” of a submitted manuscript also varies from journal to journal and some may respond after few months. Guideline time for the Review process is usually displayed on the home page of the Journal Website. The “Review Speed” is the average number of weeks it takes for an article to go through the editorial review. It consists of two components: (1)The Submission to first decision (Time to first decision) can be anywhere from 4 to 12 weeks and (2) Submission to final decision which is longer and can be up to 3 months. For e.g. The Journal of Orthopaedics has Submission to First decision time of about 6 weeks, Review and Submission to final decision time of 6–12 weeks.