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Article History

Accepted: 11 June 2026

First Online: 25 June 2026

Declarations

:

: Ethical approval for this study was obtained from the Institutional Review Committee of Pokhara University (Ref. no. 86/2081/82, dated 2081/05/15 BS). The study was conducted in accordance with the Declaration of Helsinki. All participants were informed about the purpose, objectives, and procedures of the study, and written informed consent was obtained from each participant prior to data collection. Participants were assured of their right to refuse or withdraw from the study at any time without any consequences to their medical care.

: The authors declare no competing interests.

: Not applicable.

: The datasets generated and/or analyzed during the current study are available from the corresponding author upon reasonable request.

: Not applicable.

: During the preparation of this manuscript, the authors used ChatGPT (OpenAI) to assist with language editing, grammar correction, sentence restructuring, and improvement of readability primarily in the introduction and discussion sections. The tool was used solely to enhance the clarity and presentation of the manuscript and did not contribute to the study conception, research design, data collection, data analysis, interpretation of results, or generation of scientific conclusions. The authors carefully reviewed and edited all AI-assisted outputs and take full responsibility for the accuracy, integrity, and originality of the manuscript. All original ideas, analytical approaches, results, and inferences presented in this work are the independent contributions of the authors.