Ethics approval and consent to participate
All patients provided free and informed consent to the original study, according to established ethical guidelines. Participants were verbally informed of their rights, and all provided written consent. In some cases, where decisional capacity was in doubt, a legal representative and the patient signed consent together. The research ethics committee of the Walter Cantídio University Hospital (CEP/HUWC) approved the study protocol (92598718.1.0000.5054). The study was conducted in accordance with the Declaration of Helsinki.