ISSN 1516-3180 printed version
ISSN 1806-9460 online version


Scope and indexing

São Paulo Medical Journal (formerly Revista Paulista de Medicina) was founded in 1932 and is published bimonthly by Associação Paulista de Medicina, a regional medical association in Brazil.

The Journal accepts articles in English in the fields of evidence-based health, including internal medicine, epidemiology and public health, specialized medicine (gynecology & obstetrics, mental health, surgery, pediatrics, urology, neurology and many others), and also physical therapy, speech therapy, psychology, nursing and healthcare management/administration.

São Paulo Medical Journal's articles are indexed in MEDLINE, LILACS, SciELO, Science Citation Index Expanded, Journal Citation Reports/Science Edition (ISI) and EBSCO Publishing.

Editorial policy

Papers with a commercial objective will not be accepted: please review the Journal's conflicts of interest policy below.

São Paulo Medical Journal accepts manuscripts previously deposited in a trusted preprint server.

São Paulo Medical Journal supports Open Science practices. It invites reviewers to join Open Peer Review practices through acceptance that their identities can be revealed to the authors of articles. However, this is purely an invitation: reviewers may also continue to provide their input anonymously.

São Paulo Medical Journal is an open-access publication. This means that it publishes full texts online with free access for readers.

São Paulo Medical Journal does not charge authors any "open access fees" and submission is free for all. Associação Paulista de Medicina provides financial support for the Journal.

Articles accepted for publication become the Journal's property for copyright purposes, in accordance with Creative Commons attribution type BY.

Transparency and integrity: guidelines for writing

The Journal recommends that all articles submitted should comply with the editorial quality standards established in the Uniform Requirements for Manuscripts Submitted to Biomedical Journals,1 as updated in the Recommendations for the Conduct, Reporting, Editing and Publication of Scholarly Work in Medical Journals. These standards were created and published by the International Committee of Medical Journal Editors (ICMJE) as a step towards integrity and transparency in science reporting and they were updated in December 2018.1

All studies published in São Paulo Medical Journal must be described in accordance with the specific guidelines for papers reporting on clinical trials (CONSORT),2 systematic reviews and meta-analyses (PRISMA),3,4 observational studies (STROBE),5,6 case reports (CARE)7 and accuracy studies on diagnostic tests (STARD).8,9 These guidelines ensure that all methodological procedures have been described, and that no result has been omitted. If none of the above reporting guidelines are adequate for the study design, authors are encouraged to visit the EQUATOR Network website ( to search for appropriate tools.

Conflicts of interest

Authors are required to describe any conflicts of interest that may exist regarding the research or the publication of the article. Failure to disclose any conflicts of interest is a form of misconduct.

Conflicts of interest may be financial or non-financial. The Journal recommends that the item "Conflicts of interest" at should be read to obtain clarifications regarding what may or may not be considered to be a conflict of interest. The existence and declaration of conflicts of interest is not an impediment to publication at all.

Acknowledgements and funding

Grants, bursaries and any other financial support for studies must be mentioned separately, after the references, in a section named "Acknowledgements." Any financial support should be acknowledged, always with the funding agency name, and with the protocol number whenever possible. Donation of materials used in the research can and should be acknowledged too.

This section should also be used to acknowledge any other contributions from individuals or professionals who have helped in producing or reviewing the study, and whose contributions to the publication do not constitute authorship.


The Journal supports the position taken by the ICMJE ( regarding authorship. All authors should read ICMJE's recommendations to obtain clarifications regarding the criteria for authorship and to verify whether all of them have made enough contributions to be considered authors.10

All authors of articles published in São Paulo Medical Journal need to have contributed actively to the discussion of the study results and should review and approve the final version that is to be released. If one author has not contributed enough or has not approved the final version of the manuscript, he/she must be transferred to the Acknowledgement section.

The corresponding author is the primary guarantor of all ethical issues relating to the manuscript, before, during and after its publication. However, São Paulo Medical Journal and ICMJE consider that all authors are held fully responsible for the study, regarding the accuracy or integrity of data and data interpretation in the text. Contributions such as data collection only do not constitute authorship.

The addition or deletion of authors' names in the manuscript byline is possible only if the corresponding author provides the reason for the rearrangement and a written signed agreement from all authors. Modifications to the order of the authors are possible, but also need to be justified. Authors whose names are removed or inserted must agree with this in writing. Publication of the article cannot proceed without a declaration of authorship contributions signed by all authors.

São Paulo Medical Journal supports the ORCID initiative. All authors should create an ORCID identification (ID) record (in before submitting their article and should link the submission to their existing ORCID ID in the electronic submission system. ORCID identifications help to distinguish researchers with similar names, give credit to contributors and link authors to their professional affiliations. In addition, this may increase the ability of search engines to retrieve articles.

São Paulo Medical Journal supports Open Science practices. Authors must therefore complete an open science compliance form, which is available from:

Redundant or duplicate publication

São Paulo Medical Journal will avoid publishing redundant or duplicate articles. The Journal agrees with the ICMJE definition of redundant publication,11 i.e. an attempt to report or publish the same results from a study twice. This includes but is not limited to publication of patient cohort data that has already been published, without clear reference to the previous publication. In situations in which authors are making a secondary analysis on data that has already published elsewhere, they must state this clearly. Moreover, the outcomes assessed in each analysis should be clearly differentiated.

The Journal's peer review policy and procedures

After receipt of the article through the electronic submission system, it will be read by the editorial team, who will check whether the text complies with the Journal's Instructions for Authors regarding format. The Journal has adopted the CrossRef Similarity Check system for identifying plagiarism and any text that has been plagiarized, in whole or in part, will be promptly rejected. Self-plagiarism will also be monitored.

When the general format of the manuscript is deemed acceptable and fully compliant with these Instructions for Authors, and only then, the editorial team will submit the article to the Editor-in-Chief, who will firstly evaluate its scope. If the editor finds that the topic is of interest for publication, he will assign at least two reviewers/referees with expertise in the theme, to evaluate the quality of the study. After a period varying from one to several weeks, the authors will then receive the reviewers' evaluations and will be required to provide all further information requested and the corrections that may be necessary for publication. These reviewers, as well as the Editorial Team and the Editor-in-Chief, may also deem the article to be unsuitable for publication by São Paulo Medical Journal at this point.

At the time of manuscript submission, the authors will be asked to indicate the names of three to five referees. All of them should be from outside the institution where the authors work and at least two should preferably be from outside Brazil. The Editor-in-Chief is free to choose them to review the paper or to rely on the São Paulo Medical Journal’s Editorial Board alone.

Articles will be rejected without peer review if:
- they do not present Ethics Committee approval (or a justification for the absence of this);
- they fail to adhere to the format for text and figures described here.

After peer review

Peer reviewers, associated editors and the Editor-in-Chief may ask for clarifications or changes to be made to the manuscript. The authors should then send their article back to the Journal, with the modifications made as requested. Changes to the text should be highlighted (in a different color or using a text editor tool to track changes). Failure to show the changes clearly might result in the paper being returned to the authors.

The modified article must be accompanied by a letter answering the referees' comments, point by point. The modified article and the response letter are presented to the editorial team and reviewers, who will verify whether the problems have been resolved adequately. The text and the reviewers' final evaluations, along with the response letter, will then be sent to the Editor-in-Chief for a decision.

Manuscripts that are found to be suitable for publication through their scientific merit will be considered "provisionally accepted". However, all articles will subsequently be scrutinized to check for any problems regarding the reporting, i.e. sentence construction, spelling, grammar, numerical/statistical problems, bibliographical references and other matters that may arise, especially in the Methods section. The adherence to reporting guidelines will be checked at this point, and the staff will point out any information regarding methodology or results that the authors should provide. This is done in order to ensure transparency and integrity of publication, and to allow reproducibility.

The editorial team will then provide page proofs for the authors to review and approve. No article is published without this final author approval. All authors should review the proof, although the Journal asks the corresponding author to give final approval.


Articles should be submitted only after they have been formatted as described below. Texts must be submitted exclusively through the Internet, using the Journal's electronic submission system, which is available at Submissions sent by e-mail or through the post will not be accepted.

The manuscript should be divided into two files. The first of these, the main document (“blinded”), should contain the article title, article type, keywords and abstract, article text, references and tables, but must omit all information about the authors. The second of these, the "title page", should contain all the information about the authors. To format these documents, use Times New Roman font, font size 12, line spacing 1.5, justified text and numbered pages.

The corresponding author is responsible for the submission. However, all authors should approve the final version of the manuscript that is to be submitted and should be aware of and approve any changes that might be made after peer review.

Covering letter

All manuscripts must be submitted with a covering letter signed at least by the corresponding author. The letter must contain the following five essential items relating to the manuscript:
(1) a declaration that the manuscript is original and that the text is not under consideration by any other journal;
(2) a statement that the manuscript has been approved by all authors, who agree to cede the copyrights to the Journal, disclose all sources of funding and declare all potential conflicts of interest;
(3) a statement that the study protocol was endorsed by an Internal Review Board (Ethics Committee), including the date and number of the approval (in the case of original articles). This is required for absolutely all studies involving human subjects or patient data (such as medical records), in accordance with the Committee on Publication Ethics (COPE) guidelines, and even for case reports;
(4) Each author should indicate a valid, up-to-date email address for contact;
(5) a list of a minimum of five potential referees outside of the authors' institutions, who could be invited, at the Editor-in-Chief’s discretion, to evaluate the manuscript.

General guidelines for original articles

The following are considered to be full-text original articles: clinical trials; cohort, case-control, prevalence, incidence, accuracy and cost-effectiveness studies; case series (i.e. case reports on more than three patients analyzed together); and systematic reviews with or without meta-analysis. These types of article should be written with a maximum of 3,500 words (from the introduction to the end of the conclusion).

Typical main headings in the text include Introduction, Methods, Results, Discussion and Conclusion. The authors can and should use short subheadings too, especially those concerning the reporting guideline items.

Trial and systematic review registration policy

São Paulo Medical Journal supports the clinical trial registration policies of the World Health Organization (WHO) and the International Committee of Medical Journal Editors (ICMJE) and recognizes the importance of these initiatives for registration and international dissemination of information on randomized clinical trials, with open access. Thus, since 2008, manuscripts on clinical trials are accepted for publication if they have received an identification number from one of the public clinical trial registration database (such as and/or REBEC and/or the World Health Organization; the options are stated at The identification number should be declared at the end of the abstract.  Articles describing systematic reviews must provide the protocol registration number in the PROSPERO database. Articles presenting clinical trials or systematic reviews without registration protocols will be promptly rejected without peer review.

Results from cases with DNA sequences must be deposited in appropriate public databases. The protocol number or URL can be requested at any time during the editorial review. Publication of other research data in public repositories is also recommended, since it contributes towards replicability of research, increases article visibility and possibly improves access to health information.

Sample size

All studies published in São Paulo Medical Journal must present a description of how the sample size was arrived at. If it was a convenience or purposive sample, the authors must declare so and explain the characteristics of this sample and recruitment method. For clinical trials, for instance, it is mandatory to inform each of the three main values used to calculate sample size:

- power (usually 80% or more);
- level of significance (usually 0.05 or lower);
- clinically meaningful difference (effect size targeted), according to the main outcome measurement.

Regardless of study results (if "positive" or "negative"), the journal will probably reject articles of trials using underpowered samples, when sample size has not been properly calculated or the calculation has not been fully described as indicated above.

Abbreviations, acronyms and products

Abbreviations and acronyms must not be used, even those in everyday use, unless they are defined when first used in the text. However, authors should avoid them for clarity whenever possible. Drugs or medications must be referred to using their generic names (without capital letters), with avoidance of casual mention of commercial or brand names.


All drugs, including anesthetics, should be followed by the dosage and posology used.

Any product cited in the Methods section, such as diagnostic or therapeutic equipment, tests, reagents, instruments, utensils, prostheses, orthoses and intraoperative devices, must be described together with the manufacturer's name and place (city and country) of manufacture in parentheses. The version of the software used should be mentioned.

Any other interventions, such as exercises, psychological assessments or educational sessions, should be described in enough details to allow reproducibility. The Journal recommends that the TIDieR reporting guidelines should be used to describe interventions, both in clinical trials and in observational studies.13

Short communications

Short communications are reports on the results from ongoing studies or studies that have recently been concluded for which urgent publication is important. They should be structured in the same way as original articles. The authors of this kind of communication should explain, in the covering letter, why they believe that publication is urgent. Short communications and case reports must be limited to 1,000 words (from the introduction to the end of the conclusion).

Case reports, case series, narrative reviews and letters to the editor

Starting in June 2018, only individual case reports dealing with situations of public health emergencies will be accepted by São Paulo Medical Journal. Case reports that had already been accepted for publication up to May 2018 will still be published in a timely manner.

After initial evaluation of scope by the editor-in-chief, case reports, case series and narrative reviews will be considered for peer-review evaluation only when accompanied by a systematic search of the literature, in which relevant studies found (based on their level of evidence) are presented and discussed.12 The search strategy for each database and the number of articles obtained from each database should be shown in a table. This is mandatory for all case reports, case series and narrative reviews submitted for publication. Failure to provide the search description will lead to rejection before peer review.

The access route to the electronic databases used should be stated (for example, PubMed, OVID, Elsevier or Bireme). For the search strategies, MeSH terms must be used for Medline, LILACS, and Cochrane Library. DeCS terms must be used for LILACS. EMTREE terms must be used for Embase. Also, for LILACS, the search strategy must be conducted using English (MeSH), Spanish (DeCS) and Portuguese (DeCS) terms concomitantly. The search strategies must be presented exactly as they were used during the search, including parentheses, quotation marks and Boolean operators (AND, OR, and NOT). The search dates should be indicated in the text or in the table.

Patients have the right to privacy. Submission of case reports and case series must contain a declaration that all patients gave their consent to have their cases reported (even for patients cared for in public institutions), in text and images (photographs or imaging examination reproductions). The Journal will take care to cover any anatomical part or examination section that might allow patient identification. For deceased patients whose relatives cannot be contacted, the authors should consult the Editor-in-Chief. All case reports and case series must be evaluated and approved by an ethics committee.

Case reports should be reported in accordance with the CARE Statement,7 including a timeline of interventions. They should be structured in the same way as original articles.

Case reports must not be submitted as letters. Letters to the editor address articles that have been published in the São Paulo Medical Journal or may deal with health issues of interest. In the category of letters to the editor, the text has a free format, but must not exceed 500 words and five references.

Format: for all types of articles

Title page

The title page must contain the following items:
1) Type of paper (original article, review or updating article, short communication or letter to the editor);
2) Title of the paper in English, which should be brief but informative, and should mention the study design.14 Clinical trial, cohort, cross-sectional or case-control study, and systematic review are the most common study designs. Note: the study design declared in the title should be the same in the methods and in the abstract;
3) Full name of each author. The editorial policy of the São Paulo Medical Journal is that abbreviations of authors' names must not be used; therefore, we ask that names be stated in full, without using abbreviations;
4) place or institution where the work was developed, city and country;
5) Each author should indicate the way his/her name should be used in indexing. For example: for "João Costa Andrade", the indexed name could be "Costa-Andrade J." or "Andrade JC", as preferred;
6) The author's professional background (Physician, Pharmacist, Nurse, Dietitian or another professional description, or Undergraduate Student); and his/her position currently held (for example, Master’s or Doctoral Student, Assistant Professor, Associate Professor or Professor), in the department and institution where he/she works, and the city and country (affiliations).
7) Each author should present his/her ORCID identification number (as obtained from; 
8) Each author must inform his contribution, preferably following the CRediT system (see above in Authorship);
9) Date and venue of the event at which the paper was presented, if applicable, such as congresses, seminars or dissertation or thesis presentations.
10) Sources of financial support for the study, bursaries or funding for purchasing or donation of equipment or drugs. The protocol number for the funding must be presented with the name of the issuing institution. For Brazilian authors, all grants that can be considered to be related to production of the study must be declared, such as fellowships for undergraduate, master’s and doctoral students; along with possible support for postgraduate programs (such as CAPES) and for the authors individually, such as awards for established investigators (productivity; CNPq), accompanied by the respective grant numbers.
11) Description of any conflicts of interest held by the authors (see above).
12) Complete postal address, e-mail address and telephone number of the author to be contacted about the publication process in the Journal (the "corresponding author"). This author should also indicate a postal address, e-mail address and telephone number that can be published together with the article. São Paulo Medical Journal recommends that an office address (rather than a residential address) should be informed for publication.

Second page: abstract and keywords

The second page must include the title and a structured abstract in English with a maximum of 250 words. References must not be cited in the abstract.

The following headings must be used in the structured abstract:

  • Background - Describe the context and rationale for the study;
  • Objectives - Describe the study aims. These aims need to be concordant with the study objectives in the main text of the article, and with the conclusions;
  • Design and setting - Declare the study design correctly, and the setting (type of institution or center and geographical location);
  • Methods - Describe the methods briefly. It is not necessary to give all the details on statistics in the abstract;
  • Results - Report the primary results;
  • Conclusions - Make a succinct statement about data interpretation, answering the research question presented previously. Check that this is concordant with the conclusions in the main text of the article;
  • Clinical Trial or Systematic Review Registration - Mandatory for clinical trials and systematic reviews; optional for observational studies. List the URL, as well as the Unique Identifier, on the publicly accessible website on which the trial is registered.
  • Mesh Terms - Three to five keywords in English must be chosen from the Medical Subject Headings (MeSH) list of Index Medicus, which is available at These terms will help librarians to quickly index the article.
  • Author keywords - The authors should also add three to six “author keywords” that they think express the main article themes. These keywords should be different from the MeSH terms and preferably different from words already used in the title and abstract, so that to improve the discoverability of the article by readers doing a search in PubMed. They are an additional chance for the article to be retrieved, read and cited. Combinations of words and variations (different writing, plural) are encouraged.


For any manuscript, all statements in the text that do not result from the study presented for publication in the São Paulo Medical Journal but from other studies must be accompanied by a quotation of the source of the data. All statements regarding health statistics and epidemiological data should generally be followed by references to the sources that generated this information, even if the data are only available electronically.

São Paulo Medical Journal uses the reference style known as the "Vancouver style," as recommended by the International Committee of Medical Journal Editors (ICMJE). Follow the instructions and examples at, item "References", for the format.

In the text, the references must be numbered in the order of citation. The citation numbers must be inserted after periods/full stops or commas in sentences, and in superscript (without parentheses or square brackets). References cited in the legends of tables and figures must maintain sequence with the references mentioned in the text.

In the list of references, all the authors must be listed if there are up to and including five authors; if there are six or more, the first three should be cited, followed by the expression "et al." For books, the city of publication and the name of the publishing house are mandatory. For texts published on the internet, the complete uniform resource locator (URL) or address is necessary (not only the main home page of a website or link), so that by copying the complete address into a computer internet browser, the Journal's readers will be taken to the exact document cited, and not to a general website.

At the end of each reference, please insert the "PMID" number (for papers indexed in PubMed) and the "doi" number if available.

Authors are responsible for providing a complete and accurate list of references. All references cited in the text must appear in the reference list, and every item in the reference list must be cited in the text. Also, citations must be in the correct sequence.

Manuscripts that do not follow these guidelines for references will be returned to the authors for adjustments.

The reference list should be inserted after the conclusions and before the tables and figures.

Figures and tables

Images must be submitted at a minimum size that is reproducible in the printed edition. Figures should be sent at a resolution of 300 DPI and minimum size of 2,500 pixels (width) and be recorded in ".jpg" or ".tif" format. Images submitted in inadequate formats will not be accepted.

Images must not be embedded inside Microsoft PowerPoint or Microsoft Word documents, because this reduces the image size. Authors must send the images separately, outside of .doc or .ppt documents. Failure to send the original images at appropriate sizes leads to paper rejection before peer review.

Flowcharts are an exception: these must be drawn in an editable document (such as Microsoft Word or PowerPoint), and should not be sent as an image that can’t be changed.

Figures such as bars of line graphs should be accompanied by the tables of data from which they have been generated (for example, sending them in the Microsoft Excel spreadsheets, and not as image files). This allows the Journal to correct legends and titles if necessary, and to format the graphs according to the Journal’s style. Graphs generated from software such as SPSS or RevMan must be generated at the appropriate size, so that they can be printed (see above). Authors must provide internal legends/captions in correct English.

All the figures and tables should be cited in the text. All figures and tables must contain legends or titles that precisely describe their content and the context or sample from which the information was obtained (i.e. what the results presented are and what the kind of sample or setting was). The reader should be able to understand the content of the figures and tables simply by reading the titles (without the need to consult the text), i.e. titles should be complete. Acronyms or abbreviations in figure and table titles are not acceptable. If it is necessary to use acronyms or abbreviations inside a table or figure (for better formatting), they must be spelled out in a legend below the table or figure.

For figures relating to microscopic findings (i.e. histopathological results), a scale must be embedded in the image to indicate the magnification used (just like in a map scale). The staining agents (in histology or immunohistochemistry evaluations) should be specified in the figure legend.

Documents cited

1. Internal Committee of Medical Journal Editors. Recommendations for the Conduct, Reporting, Editing, and Publication of Scholarly Work in Medical Journals. Available from: Accessed in 2019 (March 11).
2. The CONSORT Statement. Available from: Accessed in 2018 (May 3).
3. Moher D, Cook DJ, Eastwood S, et al. Improving the quality of reports of meta-analyses of randomised controlled trials: the QUOROM statement. Br J Surg 2002. Available at: Accessed in 2019 (April 4).
4. PRISMA. Transparent Reporting of Systematic Reviews and Meta-Analyses. Available from: Accessed in 2019 (April 4).
5. STROBE Statement. Strengthening the reporting of observational studies in epidemiology. What is strobe? Available from: Accessed in 2018 (May 3).
6. von Elm E, Altman DG, Egger M, et al. The Strengthening the Reporting of Observational Studies in Epidemiology (STROBE) statement: guidelines for reporting observational studies. J Clin Epidemiol. 2008;61(4):344-9. PMID: 18313558. doi: 10.1016/j.jclinepi.2007.11.008.
7. The CARE Guidelines: Consensus-based Clinical Case Reporting Guideline Development. Enhancing the QUAlity and Transparency Of health Research. Available from: Accessed in 2018 (May 3).
8. STARD Statement. STAndards for the Reporting of Diagnostic accuracy studies. Available from: Accessed in 2018 (May 3).
9. Rennie D. Improving reports of studies of diagnostic tests: the STARD initiative. JAMA. 2003;289(1):89-90. doi:10.1001/jama.289.1.89.
10. International Committee of Medical Journal Editors (ICMJE). Defining the Role of Authors and Contributors. Available from: Accessed in 2019 (March 11).
11. International Committee of Medical Journal Editors. Overlapping Publications. Available from: Accessed in 2018 (Feb 18).
12. Phillips B, Ball C, Sackett D, et al. Oxford Centre for Evidence-based Medicine Levels of Evidence (March 2009). Available from: Accessed in 2018 (May 3).
13. Hoffmann TC, Glasziou PP, Boutron I, et al. Better reporting of interventions: template for intervention description and replication (TIDieR) checklist and guide. BMJ. 2014;348:g1687. PMID: 24609605; doi: 10.1136/bmj.g1687.
14. Non-randomised controlled study (NRS) designs. Available from: Accessed in 2018 (May 3).


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