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Article History

Received: 27 August 2024

Accepted: 17 February 2025

First Online: 27 February 2025

Declarations

:

: This study was conducted in full accordance with the ethical principles outlined in the Declaration of Helsinki, as well as the guidelines established by the Council for International Organizations of Medical Sciences (CIOMS). Ethical approval was obtained from the Human Research Ethics Committee of Universiti Sains Malaysia (JEPeM), which is accredited by the Office for Human Research Protections (OHRP), United States Department of Health & Human Services, under Federalwide Assurance (FWA) number FWA000024213 and Institutional Review Board (IRB) number IRB00010568. The Committee, originally established in 1987 and currently managed under the Clinical Science Research Platform (CSRP) since 2007, has been responsible for overseeing ethical issues in research and clinical trials. All participants provided informed consent prior to their involvement in the study. Their confidentiality and anonymity were strictly maintained throughout the research process, with all data securely handled in accordance with relevant data protection regulations. Patient consent statement/Permission to reproduce material from other sources/clinical trial registration Not related.

: Informed consent to publish the images containing identifiable human faces was obtained from all individuals featured in the images. The participants were fully informed about the purpose of the research and the intended publication of the images in academic journals. All participants agreed to the use of their images for the purposes of this study and its associated publications.

: No competing interest.