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Contributors OHDB: design of the study, drafting of the manuscript. AR and MZ: data collection and analysis.
Funding This study was partly supported by an unrestricted grant from Universidad Espíritu Santo, Ecuador, Guayaquil, Ecuador.
Competing interests None.
Ethics approval The study received ethics approval from the Comite de Etica, Hospital-Clinica Kennedy, Guayaquil, Ecuador.
Provenance and peer review Not commissioned; internally peer reviewed.