The São Paulo Medical Journal: Evidence for Health Care is a peer-reviewed, continuously published online scientific journal affiliated with the São Paulo Medical Association (Associação Paulista de Medicina – APM). Established in 1932 under the title Revista Paulista de Medicina, the journal is internationally indexed and upholds the highest ethical and scientific standards. It publishes research in internal medicine and related specialties, including gynecology and obstetrics, mental health, surgery, pediatrics, public health, and preventive medicine, with a strong emphasis on evidence-based medicine and patient-centered clinical practice.

This journal follows the Open Access model, providing free and unrestricted access to all published scientific content. All manuscripts are made available under a Creative Commons Attribution (CC BY) license, which allows users to:

• Access full texts immediately and without restriction
• Download, read, and distribute content at no cost
• Use materials for academic, educational, and research purposes
• Index and process content via automated systems
• Cite and reference content without limitations

The São Paulo Medical Journal supports Open Science practices and invites peer reviewers to participate in Open Peer Review by accepting the option to disclose their identities to the manuscript’s authors. This, however, is merely an invitation; reviewers may choose to remain anonymous. 

Authors are required to complete the Open Science Compliance Form, available at Open Science Compliance Form and submit it along with other required files.

The São Paulo Medical Journal recommends that all submitted manuscripts comply with the editorial quality standards set forth in the Uniform Requirements for Manuscripts Submitted to Biomedical Journals,¹ now updated as the Recommendations for the Conduct, Reporting, Editing, and Publication of Scholarly Work in Medical Journals. These standards were developed and published by the International Committee of Medical Journal Editors (ICMJE) as a step toward promoting integrity and transparency in scientific reporting, and were last updated in December 2018.¹

All studies published in the São Paulo Medical Journal must adhere to the appropriate reporting guidelines for each study design, including: clinical trials (CONSORT),² systematic reviews and meta-analyses (PRISMA),^3,4 observational studies (STROBE),^5,6 case reports (CARE),⁷ and diagnostic accuracy studies (STARD).^8,9 These guidelines guarantee comprehensive reporting of methodological procedures and prevent the omission of results. If none of these guidelines is applicable to your study design, authors are encouraged to consult the EQUATOR Network website to identify the most appropriate tools.

Acknowledgements and Funding

Grants, financial support, and other forms of funding for studies must be disclosed in a dedicated Acknowledgements section, placed after the references. Any financial support should be acknowledged by stating the name of the funding agency and, when available, the corresponding grant number. Donations of materials used in the research may—and should—be acknowledged.

This section should also be used to recognize any additional contributions by individuals or professionals who assisted in the development or review of the study, but whose involvement does not meet the criteria for authorship.

Authorship

The journal endorses the ICMJE's position on authorship. All authors are required to read the ICMJE recommendations to guarantee they meet the authorship criteria and have contributed sufficiently to be listed as authors.¹⁰

All authors of manuscripts submitted to the São Paulo Medical Journal must have actively participated in the discussion of the study's results and must review and approve the final version of the manuscript prior to publication. If an individual has not contributed sufficiently or has not approved the final version, their name must be moved to the Acknowledgements section.

The corresponding author bears primary responsibility for all ethical matters related to the manuscript before, during, and after publication. However, both the São Paulo Medical Journal and the ICMJE consider that all listed authors share full accountability for the work, including the accuracy and integrity, and interpretation of the data presented. Tasks limited solely to data collection or similar contributions do not constitute authorship.

Adding or removing author names from the byline is only permitted when the corresponding author provides a justified explanation and a written agreement signed by all authors involved. Changes to the order of authorship are permitted but must be properly justified. Any authors whose names are added or removed must provide written consent to such changes. The manuscript cannot proceed to publication without a signed authorship contribution statement from all listed authors.

The São Paulo Medical Journal supports the ORCID initiative. All authors must create an ORCID iD (at http://www.orcid.org) prior to manuscript submission and must link their submission to their existing ORCID iDs within the electronic submission system. ORCID identifiers help distinguish researchers with similar names, guarantee proper attribution of contributions, and connect authors with their professional affiliations. Moreover, they enhance the discoverability of manuscripts through search engines.

The São Paulo Medical Journal also supports Open Science practices. Authors must complete the Open Science Compliance Form and include it among the files submitted to the journal.

Redundant or Duplicate Publications

The São Paulo Medical Journal does not accept redundant or duplicate publications. The journal adheres to the definition of redundant publication established by ICMJE,¹¹ which considers it an attempt to report or publish the results of a study more than once. This includes, but is not limited to, the publication of data from patient cohorts that have already been published elsewhere, without explicit reference to the original publication. Authors must openly declare any situation in which they are conducting secondary analyses using data previously published elsewhere. Moreover, the outcomes assessed in each analysis must be explicitly distinguished.

Ethics Committee Approval

The São Paulo Medical Journal requires a statement confirming that the study protocol was approved by an Institutional Ethics Committee, including the date and approval number (for original manuscripts). This requirement applies to all studies involving human subjects or patient data (such as medical records), in accordance with the guidelines of the Committee on Publication Ethics (COPE) — even for case reports. A copy of the ethics approval document must be submitted to the journal.

The journal accepts manuscripts written in English in the field of evidence-based healthcare, including internal medicine, epidemiology and public health, specialized medical disciplines such as gynecology and obstetrics, mental health, surgery, pediatrics, urology, neurology, among others. Submissions are also welcome in related fields, including physical therapy, speech therapy, psychology, nursing, and health services management and administration.

This journal complies with the standards defined by the SciELO Preservation Policy Program.

• Medline
• PubMed Central (PMC)
• SciELO (Scientific Electronic Library Online)
• LILACS (Latin American and Caribbean Health Sciences Literature)
• Science Citation Index Expanded – Web of Science
• Journal Citation Reports – Science Edition (ISI)
• EBSCO Publishing

• Journal Title: São Paulo Medical Journal: Evidence for Health Care 
• Abbreviated Title: Sao Paulo Med J 
• Published by: São Paulo Medical Association (Associação Paulista de Medicina – APM)
• Publication Frequency: Bimonthly 
• Publication Model: Continuous Publication (CP)
• Year of Establishment: 1932

The journal strictly adheres to the guidelines of the International Committee of Medical Journal Editors (ICMJE) and upholds the following principles:

• Peer Review: Double-blind process conducted by expert reviewers
• Scientific Integrity: Verification of originality and plagiarism detection
• Transparency: Mandatory declaration of conflicts of interest
• Ethics: Research ethics committee approval when applicable

Important Note: Manuscripts submitted for exclusively commercial or promotional purposes will not be accepted for publication.

The journal recognizes the value of preprints in accelerating the dissemination of scientific knowledge and supports their availability on reputable preprint servers. Manuscripts previously posted on recognized preprint servers are eligible for submission, provided they comply with the criteria established in this policy.

Accepted Preprint Servers

The journal accepts manuscripts deposited in the following recognized preprint repositories:

General Servers:

• bioRxiv (biological sciences)
• medRxiv (health sciences)
• arXiv (mathematics, physics, computer science)
• Research Square
• Preprints.org
• SciELO Preprints

Specialized Servers:

• PsyArXiv (psychology)
• SocArXiv (social sciences)
• ChemRxiv (chemistry)
• OSF Preprints (multidisciplinary)

Eligibility Criteria

To be accepted, preprints must meet the following criteria:

1. Trusted Repository: The preprint must be deposited in a server recognized by the scientific community.

2. Persistent Identifier: The preprint must have a DOI or an equivalent persistent identifier.

3. Date of Deposit: The preprint must include a clear indication of the date it was first posted.

4. Licensing: The license must allow use in accordance with the journal’s policies.

5. Integrity: The preprint must not contain fabricated or falsified data.

Submission Procedures

Mandatory Declaration

Authors must explicitly declare the following in the cover letter:

• Full URL of the preprint
• Date of first posting on the preprint server
• Version number of the submitted manuscript
• Main differences between the preprint and the submitted version

Transparency

• The preprint must remain publicly accessible throughout the peer review process.
• Any updates made to the preprint during the review process must be communicated to the editors.
• The final version accepted for publication must clearly indicate its relationship to the preprint.

Peer Review Process

Editorial Assessment

1. Initial Screening: Verification that the preprint meets the eligibility criteria

2. Overlap Analysis: Assessment of originality compared to other published works

3. Quality Evaluation: Application of the journal’s standard scientific quality criteria

Peer Review

• The peer review process follows the same standards applied to manuscripts that were not previously posted as preprints.
• Reviewers are informed of the existence of the preprint.
• Public comments made on the preprint server may be taken into consideration by the editors.

Publication Policy

Precedence

• Posting on a preprint server does not constitute prior publication and does not preclude submission to the journal.
• The date of acceptance by the journal establishes the official scientific precedence.
• When available, citations should prioritize the version published by the journal.

Versioning and Citation

• The final published version must include a reference to the original preprint.
• The use of ORCID identifiers is recommended for tracking different versions.
• Significant updates should result in new versions on the preprint server.

Ethical considerations

Authors’ Responsibilities

• Ensure that all co-authors have consented to the preprint submission
• Guarantee compliance with research ethics regulations
• Preserve the confidentiality of sensitive data

Limitations

Preprints will not be accepted if they:

• Contain non-anonymized patient data
• Violate confidentiality agreements
• Present preliminary outcomes that may pose a risk to public health
• Lack ethics committee approval (when applicable)

Initial Editorial Screening

All manuscripts submitted through the electronic system undergo a rigorous initial editorial screening conducted by the journal’s editorial team. This preliminary assessment verifies:

• Compliance with the author’s guidelines
• Relevance to the journal’s scope
• Completeness of ethical documentation
• Basic scientific quality and originality

Integrity Check

The journal uses the CrossRef Similarity Check system to detect plagiarism and scientific misconduct. Manuscripts found to contain:

• Full or partial plagiarism
• Significant self-plagiarism
• Duplicate publication
• Fabricated or falsified data

will be immediately rejected without undergoing peer review.

Scope Assessment

Manuscripts that meet the initial submission criteria are forwarded to the Editor-in-Chief for assessment of their editorial scope. This stage considers:

• Scientific and clinical relevance
• Alignment with the journal’s mission
• Interest to the scientific community
• Availability of qualified peer reviewers

Reviewer Selection

Selection Criteria

The journal follows a rigorous reviewer selection process based on:

• Specific expertise in the study’s subject area
• Institutional independence (no conflicts of interest)
• Geographic and cultural diversity
• Gender balance when possible
• Proven record of high-quality reviews

Nomination Process

Authors may suggest 3 to 5 potential reviewers, provided they meet the following criteria:

• All must be external to the authors’ institution
• At least two must be international (based outside Brazil)
• No recent collaborations with the authors
• Recognized expertise in the relevant field

Important: The Editor-in-Chief retains full discretion over the final selection of reviewers and may choose to accept or disregard the authors’ suggestions.

Peer Review Process

Review Model

The journal adopts a double-blind peer review model, ensuring:

• Reviewer anonymity with respect to the authors
• Author anonymity with respect to the reviewers (when feasible)
• Impartiality throughout the evaluation process
• Exclusive focus on scientific merit

Evaluation Standards

Reviewers assess manuscripts based on the following criteria:

• Originality and scientific relevance
• Appropriate and rigorous methodology
• Quality of data and statistical analyses
• Clarity in the presentation of results
• Well-founded and balanced discussion
• Compliance with reporting guidelines (e.g., CONSORT, STROBE, PRISMA)
• Regulatory and ethical aspects

Timelines and Follow-Up

• Initial Deadline: 21 days for the first review round
• Active Monitoring: Automated reminders and direct contact with reviewers
• Alternative Reviewers: Immediate identification in case of refusal
• Transparent Communication: Regular updates to authors regarding manuscript status

Immediate Rejection Criteria

Manuscripts may be rejected without peer review in case of:

• Lack of ethics approval without proper justification
• Non-compliance with formatting guidelines
• Inadequate scope for the journal
• Insufficient scientific quality
• Violation of ethical principles in research

Review Process and Response

Communication of Reviews

Authors receive:

• An editorial summary with an overall recommendation
• Detailed comments from all reviewers
• Specific guidance for revisions
• A clearly defined deadline for submitting their response

Authors’ Response

Revised manuscripts must include:

• A detailed response letter addressing each comment
• A marked-up version of the manuscript (using track changes)
• Clear justifications for any comments not addressed
• Additional documentation when requested

Second Review Round

• Verification of the appropriateness of the revisions
• Consultation with the original reviewers, when required
• Final editorial evaluation based on scientific criteria
• Transparent decision with clear justification

Editorial Decisions

Decision Categories:

• Accepted without revisions (rare)
• Accepted with minor revisions
• Accepted after major revisions
• Rejected with option for resubmission
• Definitively rejected

Provisional Acceptance

Manuscripts with demonstrated scientific merit may receive provisional acceptance and proceed to:

• Detailed technical review (language, structure, formatting)
• Verification of compliance with reporting guidelines
• Reference and supplementary data checking
• Preparation for editorial production

Editorial Transparency and Accountability

Identification of Responsible Parties

The final published version includes:

• Name of the editor responsible for the final decision
• Dates of receipt and acceptance
• Review history, when relevant
• Transparency statements regarding the editorial process

Appeals Policy

Authors may appeal editorial decisions by submitting:

• A well-founded scientific justification
• Evidence of procedural error
• Relevant new scientific information
• Request for independent editorial review

This process follows the recommendations of the International Committee of Medical Journal Editors (ICMJE), Committee on Publication Ethics (COPE), and World Association of Medical Editors (WAME).

ICMJE Recommendations for the Conduct, Reporting, Editing, and Publication of Scholarly Work in Medical Journals

Guidelines of the International Committee of Medical Journal Editors for best practices in the conduct and publication of scholarly work in medical journals.

COPE Guidelines on Good Publication Practice

Guidelines of the Committee on Publication Ethics on editorial ethics and integrity in scientific publishing.

WAME Policy Statements

Policy statements of the World Association of Medical Editors on editorial principles and scientific accountability.

Study Registration and Data Sharing Policy

Rationale and Principles

The journal strictly adheres to international guidelines on transparency and scientific integrity and fully supports the study registration policies established by the World Health Organization (WHO), International Committee of Medical Journal Editors (ICMJE), Committee on Publication Ethics (COPE), and World Association of Medical Editors (WAME).

This policy aims to promote:

• Transparency in the conduct of research
• Reduction of publication bias
• Prevention of selective finding reporting
• Facilitation of evidence synthesis
• Scientific reproducibility and replicability

Mandatory Registration of Clinical Trials

Core Requirements

All clinical trials submitted to the journal must be registered in a recognized public trial registry prior to the enrollment of the first participant. This policy applies to:

• Randomized controlled trials
• Non-randomized controlled studies
• Equivalence and non-inferiority studies
• Pragmatic and effectiveness trials
• Pilot and feasibility studies
• Prevention and intervention trials

Accepted Registries

The journal accepts trial registrations from the following primary registries recognized by the ICMJE and the WHO International Clinical Trials Registry Platform (ICTRP):

Primary Registries:

• ClinicalTrials.gov (United States)
• ISRCTN Registry (United Kingdom)
• EUCTR (European Union)
• JPRN (Japan)
• CTRI (India)
• ChiCTR (China)
• PACTR (Africa)
• SLCTR (Sri Lanka)

Recognized National Registries:

• ReBEC – Brazilian Clinical Trials Registry (Brazil)
• ANZCTR (Australia/New Zealand)
• TCTR (Thailand)
• IRCT (Iran)

Mandatory Registration Information

The trial registration must include, at least:

• A descriptive and informative title
• A unique study identifier
• Clearly defined primary outcome
• Specified secondary outcomes
• Detailed eligibility criteria
• Recruitment start date
• Planned sample size
• Contact information of the principal investigator
• Source of funding
• Ethics approval and reference number

Submission Procedures

• The registration number must be included at the end of the structured abstract
• The full URL of the registry entry must be provided
• The registration date must precede the start of the study
• The registered protocol version must be indicated
• Any post-registration modifications must be justified

Registration of Systematic Reviews and Meta-Analyses

Requirement

All systematic reviews and meta-analyses must have their protocols prospectively registered in recognized repositories prior to data collection.

Accepted Repositories

Specialized Registries:

International:

• Cochrane Library

Official repository of Cochrane systematic reviews, internationally recognized for methodological excellence.

• Joanna Briggs Institute (JBI Database)

Database of the JBI featuring systematic reviews, summarized evidence, and tools for evidence-based practice.

• Campbell Collaboration

International organization that publishes systematic reviews in fields such as education, social justice, international development, and well-being.

• PROSPERO

Prospective registry of systematic reviews in health, well-being, public policy, and social areas. It is the most widely used registry worldwide.

• Open Science Framework (OSF)

Multidisciplinary platform for registering systematic review protocols and other research projects.

• Research Registry

Accepts registrations of systematic reviews, observational studies, and clinical trials, with a focus on transparency and traceability.

• INPLASY

International platform for registering systematic review protocols, offering fast processing and DOI assignment.

• Protocol Exchange – Nature

Repository of research protocols, including systematic reviews, focused on open sharing.

National:

• ReBEC – Brazilian Clinical Trials Registry

Although primarily focused on clinical trials, it may accept protocols of systematic reviews with experimental components.

• SciELO Preprints

Accepts manuscripts of systematic review protocols prior to formal journal submission.

Mandatory Protocol Elements

• Structured research question (PICO/PECO/PIROS/PCC/PIT/SPICE)
• Detailed search strategy
• Inclusion and exclusion criteria
• Study selection process
• Planned data extraction
• Assessment of risk of bias
• Synthesis methods (qualitative/quantitative)
• Planned heterogeneity analysis
• Pre-specified subgroup analyses

Research Data Sharing

Genomic and Molecular Data

DNA, RNA, and protein sequences must be deposited in appropriate public repositories.

Recognized Repositories:

• GenBank (NCBI, United States)
• European Nucleotide Archive (ENA)
• DNA Data Bank of Japan (DDBJ)
• Protein Data Bank (PDB)
• ArrayExpress (gene expression data)
• Gene Expression Omnibus (GEO)

Mandatory Information:

• Accession numbers must be provided upon submission
• Repository URLs must be included
• Raw and processed data, when applicable
• Appropriate descriptive metadata

Clinical Research Data

Sharing Requirements

The journal encourages the deposition of clinical research data in appropriate repositories, respecting the following:

• Participant privacy
• Local and international regulations
• Ethical aspects of research
• Intellectual property rights

Recommended Repositories

General:

• Dryad Digital Repository
• Figshare
• Zenodo
• Harvard Dataverse
• Open Science Framework (OSF)

Health-Specific Repositories:

• Vivli (clinical trial data)
• Clinical Study Data Request (CSDR)
• Biosharing (repository catalog)
• SciELO Data (SciELO network) – preferred for authors from the region

SciELO Data: Preferred Regional Repository

Features and Advantages

The journal prioritizes the use of SciELO Data for authors from Latin America, the Caribbean, Spain, and Portugal, due to its alignment with open science principles.

Key Features:

• Structured and secure storage of research data
• Long-term digital preservation
• Standardized metadata following international schemas
• Native integration with the SciELO network
• Multilingual support (Portuguese, Spanish, English)

Implemented FAIR Principles:

• Findable: Rich metadata and persistent identifiers (DOI)
• Accessible: Open access with standardized protocols
• Interoperable: Standard formats and vocabularies
• Reusable: Clear licensing for use and redistribution

Integration with Publications

Direct Linking:

• Automatic connection between data and published manuscripts
• Bidirectional citation between manuscript and dataset
• Full traceability of the research process
• Synchronized versioning with updates

Compatibility:

• SciELO Preprints: Linking from the preprint stage
• SciELO Journals: Integration during the editorial process
• Other repositories: Interoperability maintained

Accepted Data Types

• Quantitative data: Spreadsheets, databases, time series
• Qualitative data: Transcripts, codes, reports
• Medical images: DICOM, NIfTI (when anonymized)
• Codes and scripts: R, Python, SPSS, Stata
• Protocols: Detailed methodologies
• Instruments: Questionnaires, validated scales

Requirements and Procedures

Data Preparation:

• Complete anonymization of personal data
• Proper documentation (README, data dictionaries)
• Preferred open formats (CSV, JSON, XML)
• Prior quality control

Deposit Process:

• Registration on the SciELO Data platform
• Upload of files and metadata
• Technical review by the SciELO team
• Assignment of DOI identifier
• Synchronized publication with the manuscript

Verification and Compliance Policy

Editorial Verification

• Automatic checking of registration numbers during submission
• Verification of consistency between registered protocol and manuscript
• Evaluation of post-registration modifications
• Confirmation of registration date versus study start date

Rejection Criteria

Manuscripts will be rejected without peer review if they:

• Do not present a valid registration number
• Were registered after the start of recruitment (without justification)
• Show substantial divergences between the protocol and the manuscript
• Were registered in a non-recognized repository

Considered Exceptions

Special cases may be evaluated individually:

• Retrospective studies with scientific justification
• Secondary analyses of existing data
• Public health emergency situations
• Documented technical limitations

Transparency and Accountability

Compliance Report

Accepted manuscripts must include:

• Statement of registration in the main text
• Clearly identified registration number(s)
• URL(s) of data repositories used
• Justifications for any deviation from the protocol
• Limitations related to data sharing

Post-Publication Monitoring

• Periodic verification of data availability
• Follow-up on updates to the registries
• Corrections when required
• Retractions in cases of proven misconduct

Author Support

Guidance and Resources

The journal provides:

• Detailed guides for study registration
• Updated list of accepted repositories
• Templates for mandatory statements
• Technical support during the submission process
• Workshops on best practices

Contact for Clarifications

For questions regarding registration and data sharing policies:

• Email: editorial@spmj.org.br
• Phone: +55 11 3188-4310; +55 11 3188-4311 (10h–17h; UTC−3)
• Online FAQ: www.spmj.br/registration-policy
• SciELO Data: data@scielo.org

Updates and Revisions

This policy is reviewed annually, considering:

• Developments in international guidelines
• Newly recognized repositories
• Feedback from the scientific community
• Regulatory changes

Normative References:

1. ICMJE Recommendations for the Conduct, Reporting, Editing, and Publication of Scholarly Work in Medical Journals
   https://www.icmje.org/recommendations/

2. International Committee of Medical Journal Editors. Recommendations for the conduct, reporting, editing, and publication of scholarly work in medical journals [Internet]. 2023 [cited 2025 Sep 26]. Available from: https://www.icmje.org/recommendations/

3. COPE Guidelines on Good Publication Practice https://publicationethics.org/guidance/Guidelines

4. Committee on Publication Ethics. COPE guidelines on good publication practice [Internet]. 2023 [cited 2025 Sep 26]. Available from: https://publicationethics.org/guidance/Guidelines

5. WAME Policy Statements
   https://www.wame.org/policy-statements

6. World Association of Medical Editors. WAME policy statements [Internet]. 2023 [cited 2025 Sep 26]. Available from: https://www.wame.org/policy-statements

7. WHO International Clinical Trials Registry Platform (ICTRP)
   https://www.who.int/clinical-trials-registry-platform

8. World Health Organization. International Clinical Trials Registry Platform (ICTRP) [Internet]. 2023 [cited 2025 Sep 26]. Available from: https://www.who.int/clinical-trials-registry-platform

9. CONSORT Statement for Reporting Randomized Trials
   http://www.consort-statement.org/

10. CONSORT Group. CONSORT 2010 statement: updated guidelines for reporting parallel group randomized trials [Internet]. 2010 [cited 2025 Sep 26]. Available from: http://www.consort-statement.org/

Since January 2025, the São Paulo Medical Journal has implemented a publication fee which corresponds to manuscript processing (Manuscript Processing Charge, APC) for all manuscripts accepted for publication. This fee is charged to the corresponding author upon acceptance of the manuscript, based on its scientific merit. The fee is R$ 1,500.00 for research conducted in Brazil and US$ 700.00 for research conducted outside Brazil. The fee applies regardless of manuscript length. The corresponding author must await receipt of the invoice before making the payment. Publication will proceed only upon confirmation of payment. Submission remains free of charge for all authors. Manuscripts submitted by members of the São Paulo Medical Association (APM) are exempt from the APC, upon proof of current membership. APM provides ongoing financial support to the journal.

The São Paulo Medical Journal follows the best practice guidelines to uphold ethics in scientific publishing, as outlined in the SciELO guide:

• Guidelines on Best Practices for Strengthening Ethics in Scientific Publication

Authors must disclose any potential conflicts of interest related to the research or publication of the manuscript. Failure to disclose such conflicts constitutes a form of misconduct.

Conflicts of interest may be financial or non-financial in nature. The journal recommends consulting the document, “Disclosure of Financial and Non-Financial Relationships and Activities, and Conflicts of Interest” for clarification on what may or may not constitute a conflict of interest. The existence and declaration of a conflict of interest does not represent an obstacle to publication.

The journal uses the CrossRef Similarity Check system to identify plagiarism. Any manuscript found to contain plagiarism, in whole or in part, will be summarily rejected. Self-plagiarism and the use of Artificial Intelligence for text generation are also subject to monitoring.

The use of Artificial Intelligence must comply with the recommendations outlined in the Guide to the Use of Artificial Intelligence Tools and Resources in research communication on the SciELO Network. The use of chatbots for text production or analysis is not recommended. If used, it must be clearly disclosed in the Abstract, properly cited within the main text, and listed in the references section. Editors and reviewers will evaluate whether the use is acceptable for publication in the journal.

The editorial team of the São Paulo Medical Journal, as well as all authors publishing in the journal, must comply with the Sex and Gender Equity in Research – SAGER Guidelines. These guidelines provide a framework for the appropriate reporting of sex and gender considerations in study design, data analysis, results, and interpretation. Additionally, the São Paulo Medical Journal maintains a gender equity policy in the composition of its editorial board.

Authors must submit a statement confirming that the study protocol received approval by an Institutional Ethics Committee, including the date and approval number (for original manuscripts). This requirement applies to all studies involving human subjects or patient data (such as medical records), in accordance with the guidelines of the Committee on Publication Ethics (COPE), including case reports. A copy of the ethics approval document must be submitted to the journal.

Authors of manuscripts accepted for publication in the São Paulo Medical Journal retain copyright ownership and license their work under the Creative Commons (CC BY 4.0) license, which allows manuscripts to be reused and distributed without restriction, provided the original work is properly cited.

All content published by the São Paulo Medical Journal, unless otherwise stated, is licensed under the CC BY 4.0 license.

Authors of manuscripts accepted for publication in the São Paulo Medical Journal retain copyright ownership and license their work under the Creative Commons (CC BY 4.0) license, which allows manuscripts to be reused and distributed without restriction, provided the original work is properly cited.

The São Paulo Medical Journal encourages authors to self-archive their accepted manuscripts by posting them on personal blogs, institutional repositories, academic networking platforms, and personal social media—provided that the full citation to the journal’s official version is included.

• São Paulo Medical Association (APM)

• Ministry of Science and Technology / National Council for Scientific and Technological Development / Ministry of Education / Coordination for the Improvement of Higher Education Personnel (MCTI/CNPq/MEC/CAPES)

• Paulo Manuel Pêgo Fernandes, Universidade de São Paulo (USP), Faculdade de Medicina, Hospital das Clínicas, São Paulo, SP, Brazil. Lattes: http://lattes.cnpq.br/6361145094736043, ORCID: https://orcid.org/0000-0001-7243-5343, E-mail: revistas@apm.org.br.

• Marianne Yumi Nakai, Faculdade de Ciências Médicas da Santa Casa de Misericórdia de São Paulo, São Paulo, SP, Brazil. Lattes: http://lattes.cnpq.br/0179930204751097, ORCID: https://orcid.org/0000-0002-1945-1472, E-mail: publicacoes@apm.org.br.

• Adriana Seber, Hospital Samaritano, São Paulo, SP, Brazil. Lattes: http://lattes.cnpq.br/4442456026252891, ORCID: https://orcid.org/0000-0003-4578-9423.
• Airton Tetelbom Stein, Universidade Federal de Ciências da Saúde de Porto Alegre (UFCSPA), Porto Alegre, Rio Grande do Sul/RS, Brazil. Lattes: http://lattes.cnpq.br/2762761928704612, ORCID: https://orcid.org/0000-0002-8756-8699.
• Alexandre Wagner Silva de Souza, University Medical Center Groningen, Groningen, Netherlands. Lattes: http://lattes.cnpq.br/7033230017001241, ORCID: https://orcid.org/0000-0001-7681-6215.
• Antonio José Gonçalves, Santa Casa de Misericórdia de São Paulo, São Paulo, SP, Brazil. Lattes: http://lattes.cnpq.br/1289845559551861.
• Aytan Miranda Sipahi, Hospital das Clínicas da Faculdade de Medicina, Universidade de São Paulo (USP), São Paulo, SP, Brazil. Lattes: http://lattes.cnpq.br/0766709471596188, ORCID: https://orcid.org/0000-0002-9686-1627.
• Cristina Muccioli, Escola Paulista de Medicina, Universidade Federal de São Paulo (UNIFESP), São Paulo, SP, Brazil. Lattes: http://lattes.cnpq.br/4512517971941945, ORCID: https://orcid.org/0000-0002-6870-6187.
• Delcio Matos, scola Paulista de Medicina, Universidade Federal de São Paulo (UNIFESP), São Paulo, SP, Brazil. Lattes: http://lattes.cnpq.br/8504991156956921, ORCID: https://orcid.org/0000-0003-0117-8786.
• Edina Mariko Koga da Silva, Escola Paulista de Medicina, Universidade Federal de São Paulo (UNIFESP), São Paulo, SP, Brazil. Lattes: http://lattes.cnpq.br/0262292376123164, ORCID: https://orcid.org/0000-0001-8080-8664.
• Fernando Antonio de Almeida, Pontifícia Universidade Católica de São Paulo (PUC-SP), Sorocaba, São Paulo/SP, Brazil. Lattes: http://lattes.cnpq.br/4798917635409404, ORCID: https://orcid.org/0000-0002-9404-9707.
• Flávio Faloppa, Escola Paulista de Medicina, Universidade Federal de São Paulo (UNIFESP), São Paulo, SP, Brazil. Lattes: http://lattes.cnpq.br/3695111273396745, ORCID: https://orcid.org/0000-0003-3688-8729.
• Heráclito Barbosa de Carvalho, Faculdade de Medicina, Universidade de São Paulo (USP), São Paulo, SP, Brazil. Lattes: http://lattes.cnpq.br/7486624029551883, ORCID: https://orcid.org/0000-0002-7037-5655.
• José Antônio Rocha Gontijo, Faculdade de Ciência Médicas, Universidade Estadual de Campinas (UNICAMP), Campinas, São Paulo/SP, Brazil. Lattes: http://lattes.cnpq.br/1548227732521661, ORCID: https://orcid.org/0000-0002-4658-385X.
• José Carlos Costa Baptista-Silva, Escola Paulista de Medicina, Universidade Federal de São Paulo (UNIFESP), São Paulo, SP, Brazil. Lattes: http://lattes.cnpq.br/7216436712130915, ORCID: https://orcid.org/0000-0002-7617-0167.
• José Maria Soares Júnior, Faculdade de Medicina, Universidade de São Paulo (USP), São Paulo, SP, Brazil. Lattes: http://lattes.cnpq.br/7115064118881203, ORCID: https://orcid.org/0000-0003-0774-9404.
• José Roberto Lapa e Silva, Universidade Federal do Rio de Janeiro (UFRJ), Rio de Janeiro, RJ, Brazil. Lattes: http://lattes.cnpq.br/3174288202051647, ORCID: https://orcid.org/0000-0003-3116-0253.
• Laércio Joel Franco, Faculdade de Medicina de Ribeirão Preto (FMRP), Ribeirão Preto, São Paulo/SP, Brazil. Lattes: http://lattes.cnpq.br/8425153214110698, ORCID: https://orcid.org/0000-0002-9820-3425.
• Leonardo Roever, Universidade Federal de Uberlândia (UFU), Uberlândia, Minas Gerais/MG, Brazil. Lattes: http://lattes.cnpq.br/4334084547427065, ORCID: https://orcid.org/0000-0002-7517-5548.
• Maria do Patrocínio Tenório Nunes, Faculdade de Medicina, Universidade de São Paulo (USP), São Paulo, SP, Brazil. Lattes: http://lattes.cnpq.br/9827180410943943, ORCID: https://orcid.org/0000-0003-3616-515X.
• Milton de Arruda Martins, Faculdade de Medicina, Universidade de São Paulo (USP), São Paulo, SP, Brazil. Lattes: http://lattes.cnpq.br/5764959219543425, ORCID: https://orcid.org/0000-0001-9690-9371.
• Moacir Fernandes de Godoy, Faculdade de Medicina de São José do Rio Preto, São José do Rio Preto, São Paulo/SP, Brazil. Lattes: http://lattes.cnpq.br/5801024266432265, ORCID: https://orcid.org/0000-0001-8390-0933.
• Olavo Pires de Camargo, Faculdade de Medicina, Universidade de São Paulo (USP), São Paulo, SP, Brazil. Lattes: http://lattes.cnpq.br/4313449638231391, ORCID: https://orcid.org/0000-0002-1128-7292.
• Renato Corrêa Baena, Faculdade de Medicina, Universidade de São Paulo (USP), São Paulo, SP, Brazil. Lattes: http://lattes.cnpq.br/6079158211920647, ORCID: https://orcid.org/0000-0003-4158-6215.
• Sergio Tufik, Escola Paulista de Medicina, Universidade Federal de São Paulo (UNIFESP), São Paulo, SP, Brazil. Lattes: http://lattes.cnpq.br/1375290481822767, ORCID: https://orcid.org/0000-0002-3804-8865.
• Vania dos Santos Nunes, Faculdade de Medicina de Botucatu, Universidade Estadual Paulista (UNESP), Botucatu, São Paulo/SP, Brazil. Lattes: http://lattes.cnpq.br/1220262621923147, ORCID: https://orcid.org/0000-0001-9316-4167.

• Abrão Rapoport, Hospital Heliópolis, São Paulo, SP, Brazil. Lattes: http://lattes.cnpq.br/6800148045579373, ORCID: https://orcid.org/0000-0002-2708-7180.
• Adriana Costa e Forti, Faculdade de Medicina, Universidade Federal do Ceará (UFC), Fortaleza, Ceará/CE, Brazil. Lattes: http://lattes.cnpq.br/8891412779514389, ORCID: https://orcid.org/0000-0002-5456-2303.
• Alexandre Fogaça Cristante, Faculdade de Medicina, Universidade de São Paulo (USP), São Paulo, SP, Brazil. Lattes: http://lattes.cnpq.br/7705881205786732, ORCID: https://orcid.org/0000-0002-7797-5274.
• Alexandre Wagner Silva de Souza, Escola Paulista de Medicina (EPM), Universidade Federal de São Paulo (UNIFESP), São Paulo, SP, Brazil. Lattes: http://lattes.cnpq.br/7033230017001241, ORCID: https://orcid.org/0000-0001-7681-6215.
• Álvaro Nagib Atallah, Escola Paulista de Medicina (EPM), Universidade Federal de São Paulo (UNIFESP), São Paulo, SP, Brazil. Lattes: http://lattes.cnpq.br/8461078281290598, ORCID: https://orcid.org/0000-0003-0890-594X.
• Auro del Giglio, Faculdade de Medicina da Fundação ABC (FMABC), Santo André, São Paulo/SP, Brazil. Lattes: http://lattes.cnpq.br/0925776607072404, ORCID: https://orcid.org/0000-0002-2009-824X.
• Carmen Cabanelas Pazos de Moura, Instituto de Biofísica Carlos Chagas Filho, Universidade Federal do Rio de Janeiro (UFRJ), Rio de Janeiro, RJ, Brazil. Lattes: http://lattes.cnpq.br/0104272542847732, ORCID: https://orcid.org/0000-0003-3944-6491.
• Cármino Antonio De Souza, Faculdade de Ciências Médicas, Universidade Estadual de Campinas (UNICAMP), Campinas, São Paulo/SP, Brazil. Lattes: http://lattes.cnpq.br/6792990308844238, ORCID: https://orcid.org/0000-0001-8656-8374.
• Dario Birolini, Faculdade de Medicina, Universidade de São Paulo (USP), São Paulo, SP, Brazil. Lattes: http://lattes.cnpq.br/7731119168634674, ORCID: https://orcid.org/0000-0002-4519-4879.
• Eduardo Maia Freese de Carvalho, Centro de Pesquisas Aggeu Magalhães, Fundação Oswaldo Cruz (FIOCRUZ), Recife, Pernambuco/PE, Brazil. Lattes: http://lattes.cnpq.br/5360319263720896, ORCID: https://orcid.org/0000-0002-8995-6089.
• Egberto Gaspar de Moura, Instituto de Biologia Roberto Alcântara Gomes, Universidade Estadual do Rio de Janeiro (UERJ), Rio de Janeiro, RJ, Brazil. Lattes: http://lattes.cnpq.br/9398848717949756, ORCID: https://orcid.org/0000-0002-1159-7549.
• Eliézer Silva, Hospital Israelita Albert Einstein, São Paulo, SP, Brazil. Lattes: http://lattes.cnpq.br/3105509847396789.
• Emílio Antonio Francischetti, Faculdade de Medicina, Universidade do Estado do Rio de Janeiro (UERJ), Rio de Janeiro, RJ, Brazil. Lattes: http://lattes.cnpq.br/5452899472778418, ORCID: https://orcid.org/0000-0001-8559-1169.
• Emmanuel de Almeida Burdmann, Faculdade de Medicina, Universidade de São Paulo (USP), São Paulo, SP, Brazil. Lattes: http://lattes.cnpq.br/6777891253014374, ORCID: https://orcid.org/0000-0002-7644-8579.
• Fabio Bessa Lima, Instituto de Ciências Biomédicas, Universidade de São Paulo (USP), São Paulo, SP, Brazil. Lattes: http://lattes.cnpq.br/0996374647319169, ORCID: https://orcid.org/0000-0003-0573-9544.
• Florence Kerr-Corrêa, Faculdade de Medicina de Botucatu, Universidade Estadual de São Paulo (UNESP), Botucatu, São Paulo/SP, Brazil. Lattes: http://lattes.cnpq.br/3156019473357572, ORCID: https://orcid.org/0000-0002-4568-2389.
• Francisco José Penna, Faculdade de Medicina, Universidade Federal de Minas Gerais (UFMG), Belo Horizonte, Minas Gerais/MG, Brazil. Lattes: http://lattes.cnpq.br/7707453847484031.
• Geraldo Rodrigues de Lima, Escola Paulista de Medicina, Universidade Federal de São Paulo (UNIFESP), São Paulo, SP, Brazil. Lattes: http://lattes.cnpq.br/0312529168917446.
• Irineu Tadeu Velasco, Faculdade de Medicina, Universidade de São Paulo (USP), São Paulo, SP, Brazil. Lattes: http://lattes.cnpq.br/7023083705677203, ORCID: https://orcid.org/0000-0001-5676-4657.
• João Renato Rebello Pinho, Hospital Israelita Albert Einstein e Faculdade de Medicina, Universidade de São Paulo (USP), São Paulo, SP, Brazil. Lattes: http://lattes.cnpq.br/5342547359165212, ORCID: https://orcid.org/0000-0003-3999-0489.
• Joel Spadaro, Faculdade de Ciências Médicas de Botucatu, Universidade Estadual de São Paulo (UNESP), Botucatu, São Paulo/SP, Brazil. Lattes: http://lattes.cnpq.br/7882433780117555.
• Jorge Sabbaga, Hospital Alemão Oswaldo Cruz, São Paulo, SP, Brazil. Lattes: http://lattes.cnpq.br/8634170443256061, ORCID: https://orcid.org/0000-0003-0715-4670.
• José Antonio Marin-Neto, Faculdade de Medicina de Ribeirão Preto, Universidade de São Paulo (USP), Ribeirão Preto, São Paulo/SP, Brazil. Lattes: http://lattes.cnpq.br/0113088308433808, ORCID: https://orcid.org/0000-0002-8651-8833.
• José Carlos Nicolau, Instituto do Coração, Hospital das Clínicas, Universidade de São Paulo (USP), São Paulo, SP, Brazil. Lattes: http://lattes.cnpq.br/6519520864855646, ORCID: https://orcid.org/0000-0002-9680-3689.
• José Fragata, Universidade Nova de Lisboa, Lisboa, Portugal. ORCID: https://orcid.org/0000-0002-4493-8178.
• José Geraldo Mill, Faculdade de Medicina, Universidade Federal do Espírito Santo (UFES), Vitória, Espírito Santo/ES, Brazil. Lattes: http://lattes.cnpq.br/2497419234600362, ORCID: https://orcid.org/0000-0002-0987-368X.
• José Mendes Aldrighi, Faculdade de Saúde Pública, Universidade de São Paulo (USP), São Paulo, SP, Brazil. Lattes: http://lattes.cnpq.br/9288664060952694, ORCID: https://orcid.org/0000-0003-4192-7876.
• José Roberto Lapa e Silva, Instituto de Doenças do Tórax, Universidade Federal do Rio de Janeiro (UFRJ), Rio de Janeiro, RJ, Brazil. Lattes: http://lattes.cnpq.br/3174288202051647, ORCID: https://orcid.org/0000-0003-3116-0253.
• Karla Soares-Weiser, Enhance Reviews Ltd, Wantage, United Kingdom. ORCID: https://orcid.org/0000-0003-4489-1629.
• Leopoldo Soares Piegas, Hospital do Coração (Hcor), Associação Beneficente Síria, São Paulo, SP, Brazil. Lattes: http://lattes.cnpq.br/7216727763603511, ORCID: https://orcid.org/0000-0003-1021-817X.
• Luiz Dratcu, Guy's Hospital, South London and Maudsley NHS Foundation Trust, London, United Kingdom. ORCID: https://orcid.org/0000-0002-5888-4991.
• Luiz Paulo Kowalski, Hospital A.C. Camargo, São Paulo, SP, Brazil. Lattes: http://lattes.cnpq.br/1030369301187376, ORCID: https://orcid.org/0000-0002-0481-156X.
• Marcelo Cypel, Toronto General Hospital, University Health Network, Toronto, Canadá. ORCID: https://orcid.org/0000-0001-5652-1938.
• Márcio Abrahão, Escola Paulista de Medicina, Universidade Federal de São Paulo (UNIFESP), São Paulo, SP, Brazil. Lattes: http://lattes.cnpq.br/4440305851848835, ORCID: https://orcid.org/0000-0003-0184-1437.
• Maria Inês Schmidt, Faculdade de Medicina, Universidade Federal do Rio Grande do Sul (UFRGS), Porto Alegre, Rio Grande do Sul/RS, Brazil. Lattes: http://lattes.cnpq.br/8044008131748129, ORCID: https://orcid.org/0000-0002-3837-0731.
• Maurício Mota de Avelar Alchorne, Universidade Nove de Julho, São Paulo, SP, Brazil. Lattes: http://lattes.cnpq.br/4370417638101124, ORCID: https://orcid.org/0009-0001-8213-9254.
• Mauro Schechter, Hospital Universitário Clementino Fraga Filho, Universidade Federal do Rio de Janeiro (UFRJ), Rio de Janeiro, RJ, Brazil. Lattes: http://lattes.cnpq.br/9560591817035298; ORCID: https://orcid.org/0000-0003-2362-9170.
• Milton Arruda Martins, Faculdade de Medicina, Universidade de São Paulo (USP), São Paulo, SP, Brazil. Lattes: http://lattes.cnpq.br/5764959219543425, ORCID: https://orcid.org/0000-0001-9690-9371.
• Nelson Hamerschlak, Hospital Israelita Albert Einstein, São Paulo, SP, Brazil. Lattes: http://lattes.cnpq.br/6838231541739860, ORCID: https://orcid.org/0000-0002-5140-5310.
• Noedir Antônio Groppo Stolf, Faculdade de Medicina, Universidade de São Paulo (USP), São Paulo, SP, Brazil. Lattes: http://lattes.cnpq.br/2193509368720092, ORCID: https://orcid.org/0000-0002-5893-8216.
• Paulo Manuel Pêgo Fernandes, Instituto do Coração, Hospital das Clínicas, Faculdade de Medicina, Universidade de São Paulo (USP), São Paulo, SP, Brazil. Lattes: http://lattes.cnpq.br/6361145094736043, ORCID: https://orcid.org/0000-0001-7243-5343.
• Pérsio Roxo Júnior, Faculdade de Medicina de Ribeirão Preto, Universidade de São Paulo (USP), Ribeirão Preto, São Paulo/SP, Brazil. Lattes: http://lattes.cnpq.br/7729371242416179, ORCID: https://orcid.org/0000-0001-6318-4132.
• Raul Cutait, Hospital Sírio-Libanês, São Paulo, SP, Brazil. Lattes: http://lattes.cnpq.br/5019797602485597, ORCID: https://orcid.org/0000-0002-2150-3753.
• Raul Marino Junior, Faculdade de Medicina, Universidade de São Paulo (USP), São Paulo, SP, Brazil. Lattes: http://lattes.cnpq.br/3195808320924765.
• Ricardo Brandt de Oliveira, Faculdade de Medicina de Ribeirão Preto, Universidade de São Paulo (USP), Ribeirão Preto, São Paulo/SP, Brazil. Lattes: http://lattes.cnpq.br/0520053327074970.
• Roberto Alexandre Franken, Faculdade de Ciências Médicas, Santa Casa de Misericórdia de São Paulo, São Paulo, SP, Brazil. Lattes: http://lattes.cnpq.br/9539259035398662, ORCID: https://orcid.org/0000-0003-0140-6865.
• Soubhi Kahhale, Faculdade de Medicina, Universidade de São Paulo (USP), São Paulo, SP, Brazil. Lattes: http://lattes.cnpq.br/2153367481504669, ORCID: https://orcid.org/0009-0003-3397-9892.
• Tirone Espiridião David, Toronto General Hospital, Toronto, Canadá. ORCID: https://orcid.org/0000-0002-1676-8052.
• Wadih Arap, MD Anderson Cancer Center, University of Texas, Houston, Estados Unidos. ORCID: https://orcid.org/0000-0002-8686-4584.
• Wilson Roberto Catapani, Faculdade de Medicina do ABC, Santo André, São Paulo/SP, Brazil. Lattes: http://lattes.cnpq.br/3761254264695648, ORCID: https://orcid.org/0000-0002-0412-2182.
• Wellington V. Cardoso, Boston University, Boston, Estados Unidos. ORCID: https://orcid.org/0000-0002-2550-3697.

• Thiago Vieira da Silva, Analista de Publicações, Associação Paulista de Medicina (APM) São Paulo, SP, Brazil. Lattes: http://lattes.cnpq.br/6531349105452619, ORCID: https://orcid.org/0000-0001-6299-0386, e-mail: revistas@apm.org.br.
• Felipe Cotrim, Assistente de Publicações, Associação Paulista de Medicina (APM), São Paulo/SP, Brazil. Lattes: http://lattes.cnpq.br/1271163470800280, ORCID: https://orcid.org/0000-0001-9429-2427, e-mail: publicacoes@apm.org.br.
• Maria Eduarda dos Santos Puga. Bibliotecária. Lattes: http://lattes.cnpq.br/0215929415693389, ORCID: https://orcid.org/0000-0001-8470-861X; e-mail: mespuga@yahoo.com.br 

• English Language Editing: Editage
• Electronic Publishing:

All papers approved for final publication in the São Paulo Medical Journal will receive their Digital Object Identifier (DOI).

The São Paulo Medical Journal accepts manuscripts in the scientific fields of health, including internal medicine, gynecology and obstetrics, mental health, surgery, pediatrics, and public health. 

The journal accepts submissions of original manuscripts in the following formats:

• clinical studies
• cohort studies
• case-control studies
• prevalence or incidence studies
• diagnostic accuracy studies
• cost-effectiveness studies
• systematic reviews with or without meta-analysis
• scoping reviews

Other accepted types:

• narrative literature reviews
• case reports
• brief communications
• letters to the editor 

Commercially motivated manuscripts will not be accepted. 

In the document containing authors’ information, each author’s individual contribution must be described in accordance with the CRediT taxonomy.

Manuscripts must only be submitted after being formatted as described below. Texts must be submitted exclusively online, through the journal’s electronic submission system, available at https://periodicosapm.emnuvens.com.br/spmj/about/submissions. Submissions sent by email or postal service will not be accepted.

Note: Manuscripts submitted before January 2025 will continue their review process via ScholarOne and can be accessed through the following link: http://mc04.manuscriptcentral.com/spmj-scielo.

The manuscript must be divided into two files. The first file, which is the main document (blinded, i.e., with all author-identifying information removed), must contain:

• manuscript type
• manuscript title (in English)
• keywords
• abstract
• main text
• references
• tables and figures (each accompanied by their respective titles and captions)

The second file, called the “title page,” must include all author information, as described in these instructions. 

When formatting these documents, use Times New Roman font, size 12, 1.5 line spacing, justified alignment, and numbered pages (line numbering is not required).

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

Cover Letter

All manuscripts must be submitted with a cover letter signed by at least the corresponding author. The letter must include the following five essential items related to the manuscript:

1. a statement confirming that the manuscript is original and that it is not under consideration for publication by any other journal.

2. a statement that the manuscript has been approved by all authors, listing all funding sources and disclosing any potential conflicts of interest.

3. a statement confirming that the study protocol was approved by an Institutional Ethics Committee, including the date and approval number (in the case of original research manuscripts). This requirement applies to all studies involving human subjects or patient data (such as medical records), in conformity with the guidelines of the Committee on Publication Ethics (COPE), including case reports. A copy of the ethics approval document must be submitted to the journal.

4. each author must provide a valid and up-to-date email address for contact purposes.

5. a list of at least five potential reviewers from outside the authors' institutions, who may be invited at the discretion of the Editor-in-Chief to evaluate the manuscript.

General Guidelines for Original Manuscripts

The following categories are considered full original manuscripts: clinical studies; cohort, case-control, prevalence, incidence, accuracy, and cost-effectiveness studies; case series (i.e., case reports involving more than three patients analyzed collectively); and systematic reviews with or without meta-analysis. These types of manuscripts must be written with a maximum of 3,500 words (from the Introduction to the end of the Conclusions section).

Typical sections include: Introduction, Objective, Methods, Results, Discussion, and Conclusions. Authors may—and are encouraged to—use subsections as well, particularly when reporting items required by reporting guidelines.

Clinical Trial and Systematic Review Registration Policy

The São Paulo Medical Journal supports the trial registration policies established by the World Health Organization (WHO) and the ICMJE and acknowledges the importance of these initiatives for the global registration and open-access dissemination of information from randomized clinical trials. Therefore, since 2008, manuscripts reporting clinical trials are only accepted for publication if they have been assigned an identification number from a public clinical trial registry (such as ClinicalTrials.gov and/or ReBEC and/or WHO; options are listed at http://www.icmje.org). This identification number must be declared at the end of the abstract. Manuscripts describing systematic reviews must provide a protocol registration number from a trusted database, such as PROSPERO, Open Science Framework, Cochrane, Joanna Briggs Institute, among others. Manuscripts presenting clinical trials or systematic reviews without protocol registration will be promptly rejected without peer review.

Case reports involving DNA sequences must have those sequences deposited in appropriate public databases. The protocol number or resource locator (URL) may be requested at any time during the editorial review process. The publication of other research data in public repositories is also encouraged, as it supports research reproducibility, enhances manuscript visibility, and potentially increases access to health-related information.

Sample Size

All studies published in the São Paulo Medical Journal must include a description of how the sample size was determined. If a convenience or purposive sample was used, the authors must clearly state this and explain the sample’s characteristics and the recruitment method. For clinical trials, it is mandatory to report each of the three main parameters used in the sample size calculation:

• power (typically 80% or higher)
• significance level (usually 0.05 or lower)
• clinically meaningful difference (desired clinical effect size), based on the study’s primary outcome

Regardless of the study results (whether “positive” or “negative”), the journal will likely reject manuscripts from underpowered studies if the sample size calculation was not adequately conducted or properly described in the manuscript, as outlined above.

Abbreviations, Acronyms, and Products

Abbreviations and acronyms—even those commonly used—should not be used unless they are defined at first mention in the text. However, authors should avoid using them when possible, to guarantee clarity of writing. Drugs or medications must be referred to by their generic names (in lowercase), and commercial or brand names should be avoided in casual reference.

Interventions

All drugs, including anesthetics, must be followed by the dosage and regimen used.

Any product mentioned in the Methods section, such as diagnostic or therapeutic equipment, tests, reagents, instruments, utensils, prostheses, orthoses, and intraoperative devices, must be described along with the manufacturer’s name and location (city and country) in parentheses. Software versions (computer programs) must also be cited.

Any other interventions, such as exercise routines, psychological evaluations, or educational sessions, must be described in sufficient detail to allow reproducibility. The journal recommends using the TIDieR reporting guidelines to describe interventions, both for clinical and observational studies.¹³

Supplementary Material

As supplementary material refers to documents not part of the manuscript text, the São Paulo Medical Journal will not publish it. Authors must provide a link that allows readers to access any supplementary content.

Short Communications

Short communications are brief reports of ongoing research or recently completed studies for which urgent publication is important. These texts must be structured in the same format as original manuscripts. Authors submitting this type of manuscript must explain in their cover letter why they believe the publication is urgent. Short communications and case reports are limited to 1,000 words (from the Introduction to the end of the Conclusions section).

Case Reports, Case Series, Narrative Reviews, and Letters to the Editor

As of June 2018, the São Paulo Medical Journal only accepts individual case reports that address public health emergencies. 

After an initial scope evaluation by the Editor-in-Chief, case reports, case series, and narrative reviews will only be considered for peer review if accompanied by a systematic literature search, in which relevant studies (based on their level of evidence) are presented and discussed. The search strategy for each database and the number of manuscripts retrieved from each must 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 result in rejection before peer review.

The access route to each database used must be indicated (e.g., PubMed, OVID, Elsevier, or Bireme). For search strategies, MeSH terms must be used for Medline, LILACS, and Cochrane Library; DeCS terms must be used for the LILACS database; EMTREE terms must be used for Embase. Additionally, for LILACS, the search strategy must be conducted using terms in English (MeSH), Spanish (DeCS), and Portuguese (DeCS) simultaneously. Search strategies must be presented exactly as used during the search, including parentheses, quotation marks, and Boolean operators (AND, OR, and NOT). The dates on which the searches were conducted must be stated in the text or in the table.

Patients have a right to privacy. Submissions of case reports and case series must include a statement confirming that all patients gave their consent to have their cases reported (even patients treated at public institutions), including both text and images (photographs or imaging scans). The Journal will ensure that any anatomical features or imaging data that could allow for patient identification are obscured. In cases involving deceased patients whose family members could not be contacted, authors should consult the Editor-in-Chief. All case reports and case series must be reviewed and approved by an ethics committee.

Case reports must be written in accordance with the CARE Statement7 (including a timeline of interventions) and should follow the same structure as original manuscripts.

Case reports should not be submitted as letters. Letters to the Editor may comment on manuscripts published by the São Paulo Medical Journal or address relevant healthcare issues. Letters are unstructured but should not exceed 500 words and five references.

Title Page

The title page must include the following items:

1. Type of manuscript (original manuscript, review or update manuscript, short communication, or letter to the editor).

2. Title of the manuscript in English, which should be short and informative, and must mention the study design. Clinical trial, cross-sectional study, cohort study, case-control study, and systematic review are the most common study designs. Note: the study design stated in the title must match what is described in the Methods section and the Abstract.

3. Full name of each author. The editorial policy of the São Paulo Medical Journal requires that author names be written in full, without abbreviations or initials.

4. Institution or location where the work was conducted, including city and country;

5. Each author must indicate how their name should appear in indexing. For example, an author named “João Costa Andrade” may choose to be indexed as “Costa-Andrade J” or “Andrade JC,” according to preference.

6. The professional background of each author must be indicated (physician, pharmacist, nurse, nutritionist, or other description, or undergraduate student), along with their current position (e.g., master’s or doctoral student, assistant professor, associate professor, or adjunct professor) within the department and institution where they work, and the city and country (affiliations).

7. Each author must provide their ORCID identification number (available at www.orcid.org).

8. Contribution of each author, preferably following the CRediT taxonomy system (see Authorship above).¹⁰

9. Date and location of the event where the work was presented, if applicable, such as congresses, seminars, or thesis/dissertation presentations.

10. Sources of financial support for the study, including grants or funding for the purchase or donation of equipment or drugs. The protocol number for the funding must be provided along with the name of the issuing institution. For Brazilian authors, all scholarships can be considered as related to the study and must be disclosed. This includes scholarships for undergraduate, master’s, and doctoral students, as well as possible support for graduate programs (such as CAPES) and individual author support, like productivity grants from CNPq, accompanied by the respective funding number.

11. Disclosure of any conflicts of interest by the authors (see above).

12. Full address, email, and phone number of the author to be contacted regarding the journal’s publication process (the “corresponding author”). This author must also provide the address, email, and phone number to be published with the manuscript. The São Paulo Medical Journal recommends that a professional address (not a residential one) be provided for publication.

Abstract and Keywords

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

The following headings must be used in the structured abstract:

• Background – Briefly describe the context and rationale for the study;
• Objectives – Clearly state the objectives of the study. These must match the study objectives stated in the main body of the manuscript and the conclusions;
• Design and setting – Accurately describe the study design and the setting (type of institution or center and geographic location);
• Methods – Briefly describe the methods. Detailed statistical information is not required in the abstract;
• Results – Report the primary results;
• Conclusions – Provide a concise statement interpreting the findings, directly answering the scientific question previously stated. Ensure that this conclusion is consistent with those in the main text of the manuscript;
• Clinical Trial or Systematic Review Registration – Registration is mandatory for clinical trials and systematic reviews; it is optional for observational studies. Please provide the full URL of the publicly accessible website where the study was registered, along with the Unique Identifier (identification or protocol number) of the study;
• MeSH Terms – Three to five keywords in English must be selected from the Index Medicus list of Medical Subject Headings (MeSH), available at: http://www.ncbi.nlm.nih.gov/sites/entrez?db=mesh. Other keywords will not be accepted. These terms assist librarians in quickly indexing the manuscript;
• Author Keywords – Authors must also provide three to six “author keywords” that they believe best represent the main themes of the manuscript. These keywords should be different from the MeSH terms and, preferably, from the words used in the title and abstract to improve the manuscript’s discoverability by readers searching in PubMed. They offer an additional opportunity for the manuscript to be found, read, and cited. Word combinations and variations (e.g., alternative spelling, plural forms) are recommended.

Images must be submitted at a size suitable for reproduction in the printed version of the journal. Figures should have a resolution of 300 DPI and a minimum width of 2,500 pixels, saved in “.jpg” or “.tif” formats. Images submitted in incorrect formats will not be accepted.

Images must not be embedded within Microsoft PowerPoint or Word documents, as this reduces their quality. Authors should upload image files separately, rather than inserting them into .doc or .ppt files. Failure to provide original images at the required resolution will result in rejection of the manuscript prior to peer review.

Flowcharts are an exception: these must be created in an editable document (e.g., Microsoft Word or PowerPoint) and should not be submitted as non-editable image files.

Figures such as bar charts and line graphs must be accompanied by the data tables from which they were produced (e.g., sent as Microsoft Excel spreadsheets, not image files). This allows the Journal to edit captions and titles if required and to format the graphics according to the journal’s style. Charts generated using software such as SPSS or RevMan must be produced at a size suitable for print publication (see specifications above). Authors must provide correct English-language internal captions.

All figures and tables must be cited in the main text. They must also include titles or legends that accurately describe their content, as well as the context or sample from which the data were obtained (i.e., what the results represent and what type of sample or context is involved). Readers must be able to understand the content of the figures and tables based solely on their titles, without needing to refer to the text. In other words, titles must be self-explanatory and complete. Acronyms or abbreviations must not be used in the titles of figures or tables. If abbreviations must be used within the figure or table body (due to formatting constraints), they should be explained in a footnote or legend below the table or figure.

For figures that present microscopic results (e.g., histopathological results), a scale bar must be included in the image to indicate the magnification used (similar to a map scale). Staining agents (used in histology or immunohistochemistry) must be specified in the figure legend.

In all manuscripts, any statement that does not originate from the study being reported in the São Paulo Medical Journal must be accompanied by a citation of the original source. All claims related to health statistics or epidemiological data should, as a rule, be supported by references to the sources from which the information was obtained, even when the data are available only electronically.

Following ICMJE recommendations, the São Paulo Medical Journal adopts the Vancouver style for authors and editors. Please consult the instructions and examples available at http://www.icmje.org (References section), or https://www.ncbi.nlm.nih.gov/books/NBK7256/ to ensure proper formatting.

In-text citations must be numbered in the order they appear in the manuscript. Citation numbers should be inserted after periods or commas, in superscript format (without parentheses or brackets). References cited in table and figure legends must follow the same numbering sequence used in the main body of the text.

In the reference list, list all authors when there are up to five. For six or more authors, list the first three, followed by “et al.” For books, the city of publication and the publisher’s name are required. For online publications, a complete URL or direct address must be provided (not just the homepage), so that copying and pasting the full link into a browser leads readers directly to the cited document, rather than to a general website.

At the end of each reference, insert the PMID number (for manuscripts indexed in PubMed: https://pubmed.ncbi.nlm.nih.gov/) and the DOI link, when available, or any other direct access link to the cited document.

Authors are responsible for submitting a complete and accurate reference list. All references cited in the text must appear in the reference list, and vice versa. Additionally, citations must be in the correct sequential order.

Conflicts of Interest

Authors must disclose any potential conflicts of interest related to the research or the publication of the manuscript. Failure to disclose such conflicts is considered a form of misconduct.

Conflicts of interest may be financial or non-financial. The journal recommends consulting the document, “Conflicts of Interest” available at http://www.icmje.org for clarification on what may or may not constitute a conflict of interest. The existence and declaration of a conflict of interest does not preclude publication.

Manuscripts that do not adhere to the reference formatting guidelines will be returned to the authors for correction.

The reference list must be inserted after the Conclusions section and before any tables and figures.

Cited Documents

1. Internal Committee of Medical Journal Editors. Recommendations for the Conduct, Reporting, Editing, and Publication of Scholarly Work in Medical Journals. Available from: http://www.icmje.org/recommendations/. Accessed in 2019 (March 11).

2. The CONSORT Statement. Available from: http://www.consort-statement.org/ 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: https://onlinelibrary.wiley.com/doi/abs/10.1046/j.1365-2168.2000.01610.x. Accessed in 2019 (April 4).

4. PRISMA. Transparent Reporting of Systematic Reviews and Meta-Analyses. Available from: www.prisma-statement.org. Accessed in 2019 (April 4).

5. STROBE Statement. Strengthening the reporting of observational studies in epidemiology. What is strobe? Available from: http://www.strobe-statement.org/. 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. https://doi.org/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: https://www.equator-network.org/reporting-guidelines/care/. Accessed in 2018 (May 3).

8. STARD Statement. STAndards for the Reporting of Diagnostic accuracy studies. Available from: http://www.equator-network.org/reporting-guidelines/stard/. Accessed in 2018 (May 3).

9. Rennie D. Improving reports of studies of diagnostic tests: the STARD initiative. JAMA. 2003;289(1):89-90. https://doi.org/10.1001/jama.289.1.89.

10. International Committee of Medical Journal Editors (ICMJE). Defining the Role of Authors and Contributors. Available from: http://www.icmje.org/recommendations/browse/roles-and-responsibilities/defining-the-role-of-authors-and-contributors.html. Accessed in 2019 (March 11).

11. International Committee of Medical Journal Editors. Overlapping Publications. Available from: http://www.icmje.org/recommendations/browse/publishing-and-editorial-issues/overlapping-publications.html. 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: https://www.cebm.net/2009/06/oxford-centre-evidence-based-medicine-levels-evidence-march-2009/. 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; https://doi.org/10.1136/bmj.g1687.

14. Non-randomised controlled study (NRS) designs. Available from: http://childhoodcancer.cochrane.org/non-randomised-controlled-study-nrs-designs. Accessed in 2018 (May 3).

Required Supplementary Documents

Submission Forms Required

All manuscripts must be submitted along the following mandatory documents:

1. Open Science Compliance Form

• Purpose: Declaration of adherence to FAIR principles and open science practices
• Mandatory content: 
  • Provision of raw data (when applicable)
  • Sharing of analysis code
  • Use of persistent identifiers (ORCID, DOI)
  • Statement on preprints
  • Open access policies followed
• Format: Electronic form integrated into the submission system
• Download: Available at https://wp.scielo.org/wp-content/uploads/Open-Science-Compliance-Form_en.docx

2. Authorship and Contributions Declaration (CRediT)

• Purpose: Detailed specification of each author's contributions
• CRediT taxonomy includes: 
  • Conceptualization
  • Data curation
  • Formal analysis
  • Funding acquisition
  • Investigation
  • Methodology
  • Project administration
  • Resources/materials
  • Software/tools
  • Supervision
  • Validation
  • Data visualization
  • Writing – original draft
  • Writing – review & editing
• Requirement: All authors must sign electronically

3. Agreement and Copyright Transfer Statement

• Required elements: 
  • Declaration of originality and absence of prior publication
  • Approval by all co-authors
  • Agreement with Creative Commons licensing (CC BY)
  • Statement of responsibility for content and accuracy
• Signature: Corresponding author on behalf of all co-authors
• File: Digitally signed PDF document

4. Proof of Ethical Approval

Mandatory for all studies involving:

• Human subjects (including retrospective data)
• Human biological samples
• Laboratory animals
• Studies involving communities or vulnerable populations

Accepted documents:

• Approval statement from a Research Ethics Committee (CEP)
• Certificate of approval from an Animal Use Ethics Committee (CEUA)
• Ethical exemption statement with justified rationale
• Approvals from recognized international ethics committees

Required information:

• Protocol/approval number
• Date of approval
• Responsible institution
• Validity period of the approval
• Approved amendments or modifications

5. Conflicts of Interest Statement

Based on ICMJE guidelines, the statement must include:

Financial Conflicts:

• Relationships with pharmaceutical or medical device companies
• Industry funding
• Patents or royalties
• Stock ownership
• Paid consultancies
• Honoraria for lectures

Non-Financial Conflicts:

• Personal or family relationships
• Political or religious beliefs
• Relevant academic affiliations
• Mentorship relationships

Form: Based on the ICMJE standard (http://www.icmje.org/conflicts-of-interest/)

6. Informed Consent Form (when applicable)

• For case reports: A specific informed consent form (ICF) for publication
• For patient images: Explicit authorization for their use
• For retrospective data: Ethical approval with waiver or ICF
• Anonymization Standard: Follow COPE guidelines

Study-Specific Documents

Clinical Trials

• Full study protocol (approved version)
• Proof of registration in a recognized platform
• Randomization manual (if applicable)
• Completed CONSORT checklist

Systematic Reviews

• Registered protocol (PROSPERO or equivalent)
• Detailed search strategies for all databases
• List of excluded studies with justifications
• Completed PRISMA checklist

Observational Studies

• Completed STROBE checklist
• Participant selection flowchart
• Pre-specified statistical protocol

Case Reports

• Completed CARE checklist
• Detailed timeline of events
• Systematic literature review

Transparency Requirements

All manuscripts must include a dedicated funding section, following the ICMJE, COPE, and WAME guidelines for financial transparency.

Mandatory Information

1. Funding Sources:

• Funding agencies (full name and acronym)
• Specific grant/contract numbers
• Duration of the funding period
• Total amount or funding range
• Type of support (scholarship, grant, equipment, infrastructure)

Example of correct formatting:

This study was funded by the São Paulo Research Foundation (FAPESP, grant number 2023/12345-6), the National Council for Scientific and Technological Development (CNPq, grant number 123456/2023-8), and the Coordination for the Improvement of Higher Education Personnel (CAPES, Funding Code 001).

2. Role of the Funding Sources:

• Study design: Any influence on the study conception
• Data collection: Involvement in operational execution
• Data analysis and interpretation: Participation in drawing conclusions
• Manuscript writing: Contribution to writing the manuscript
• Decision to publish: Influence on submission decisions

3. Institutional Support:

• Infrastructure provided by the institution
• Protected time for research activities
• Dedicated human resources
• Availability of equipment and materials

Special Cases

No Funding:

This study received no specific grant from funding agencies in the public, commercial, or not-for-profit sectors.

Industry Funding:

This study received financial support from [Company Name]. The company had no role in the design of the study, data collection, data analysis or interpretation, or manuscript writing.

Mixed Funding: Each funding source and its specific role in the project must be clearly specified.

Related Conflicts of Interest

Any relationship between funders and authors must be disclosed:

• Employment relationships
• Consulting activities
• Participation on advisory boards
• Intellectual property
• Direct or indirect benefits

Data and Supplementary Materials

Supplementary Materials Policy

The journal does not publish supplementary materials as part of the main publication. Instead, authors should:

1. Deposit in Appropriate Repositories:

• Raw data: SciELO Data, Dryad, Figshare
• Analysis codes: GitHub, OSF, Zenodo
• Detailed protocols: protocols.io
• Additional images: Specialized repositories

2. Provide Access Links:

• Permanent URLs for all materials
• DOI identifiers when available
• Access codes if required
• Instructions for access and use

Types of Materials Accepted via Repository

Quantitative Data:

• Complete datasets (CSV, Excel format)
• Statistical analysis code (R, Python, SPSS, Stata)
• Results from additional analyses
• Metadata and variable dictionaries

Qualitative Materials:

• Interview guides
• Focus group guides
• Coding trees
• Examples of thematic analysis

Methodological Resources:

• Expanded protocols
• Validated data collection instruments
• Training manuals
• Standard operating procedures

Visual Materials:

• High-resolution images
• Demonstration videos
• Interactive figures
• Technical presentations

Mandatory Declaration

All manuscripts must include a "Data Availability" statement specifying:

“The data supporting the findings of this manuscript are available at [repository name] via DOI: [number]. Additional data are available from the corresponding author upon reasonable request.”

Levels of Data Sharing

1. Full Open Access:

• All data publicly available
• No usage restrictions
• A clear Creative Commons license is provided

2. Controlled Access:

• Sensitive data available upon justified request
• A data access committee oversees requests
• Transparent request procedures are described

3. Non-Shareable Data:

• Ethical or legal restrictions are clearly justified
• Alternatives resources are offered (e.g., synthetic or aggregated data)
• A commitment to the highest possible level of transparency is maintained

Acknowledgements

Recommended Structure

1. Non-Author Contributions:

• Specialized technical assistance
• Statistical support
• Language editing
• Administrative support
• Provision of materials

2. Research Participants:

• Acknowledgment of volunteers
• Recognition of involved communities
• Mention of collaborating institutions

3. Institutional Support:

• Departments and laboratories
• Committees and research groups
• Collaboration networks
• Utilized infrastructure

Regulatory Compliance: This adheres to the guidelines of the ICMJE (International Committee of Medical Journal Editors s), COPE (Committee on Publication Ethics), and WAME (World Association of Medical Editors).

Associação Paulista de Medicina
Av. Brigadeiro Luís Antônio, 278, Bela Vista, São Paulo-SP, Zip code 01318-901
Phone: +55 11 3188-4310; +55 11 3188-4311 (10h–17h; UTC−3)
E-mail: revistas@apm.org.br; publicacoes@apm.org.br