Declarations. Competing interests: The author(s) declare no competing interests. Ethical approval: The study protocol was reviewed and approved by the Institutional Review Board of the Universidad Autónoma de Sinaloa’s School of Medicine. All procedures performed in this study involving human participants were in accordance with the ethical standards of the institutional and national research committee and with the 1964 Helsinki Declaration and its later amendments or comparable ethical standards. Consent to participate: Informed consent was obtained from all individual participants included in the study. Participants were fully informed about the study’s purpose, procedures, potential risks, and their right to withdraw at any time, prior to their enrollment. Consent to publish: Participants were informed that their anonymized data would be used for research and publication purposes, and consent to publish was obtained through the informed consent process. No identifiable personal details of any participants are included in this manuscript.