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Article History

Received: 10 August 2025

Accepted: 24 March 2026

First Online: 1 April 2026

Declarations

:

: Ethical clearance for this study was obtained from the SPHMMC Institutional Review Board (Ref. No. PM 23/336, dated December 15, 2022). Formal permission was also secured from the Department of Internal Medicine prior to data collection. All eligible participants provided informed consent after the study objectives were explained. Written consent was obtained from those able to sign; for participants unable to provide a signature, verbal consent was documented by the data collector and witnessed by an independent observer to ensure compliance with ethical standards. Participants were informed that their participation was voluntary and that they could withdraw at any time without consequences. To maintain confidentiality, no personal identifiers were recorded, and all information was kept strictly confidential and used solely for research purposes. The study was conducted from February 1 and July 30, 2023, in accordance with the ethical principles of the Declaration of Helsinki.

: Not relevant.

: The authors declare no competing interests.