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Article History

Received: 4 October 2025

Accepted: 22 January 2026

First Online: 3 February 2026

Declarations

:

: The Vice-Chancellor approved the study protocol for Research and Technology of Lorestan University of Medical Sciences and the Research Ethics Committee of Lorestan University of Medical Sciences, Khorramabad, Iran (Approval code: IR.LUMS.REC0.1403.329). Written and oral informed consent was obtained from the legal guardians of all participants prior to enrollment. All procedures were conducted in accordance with the ethical standards of the institutional research committee, the principles of the Declaration of Helsinki (1964) and its later amendments, with strict attention to patient confidentiality. Ethical principles, including respect for dignity, autonomy, justice, and beneficence, were fully observed throughout the study. The clinical care and routine medications of patients were neither withheld nor altered, and participants’ safety and well-being were prioritized at all times. The trial was discontinued immediately if consent was withdrawn or the patient’s condition deteriorated.

: Not applicable.

: The authors declare no competing interests.

: Artificial intelligence tools (ChatGPT, OpenAI) were used solely to assist with English translation, language polishing, and figure preparation (one CONSORT diagram). They were not used for data analysis, statistical interpretation, or the generation of scientific content. All intellectual responsibility for the content remains with the authors.