1659-4223 1659-4223 S1659-42232022000200211 10.15517/rehmlac+.v14i2.51583 Ecuador 00 12 2022 00 12 2022 14 2 211 220 2019 11 1 1 136-50 2019 10 2 2 277-91 2010 1 . 2 . 2 159-67