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Article History

Received: 13 November 2025

Accepted: 25 November 2025

First Online: 3 December 2025

Declarations

:

: This study was conducted under the ethical principles outlined in the Declaration of Helsinki. Ethical approval was obtained from the Ethics Committee of Mashhad University of Medical Sciences (IR.MUMS.REC.4040006, 20 November 2024). The research protocol was reviewed to ensure that it protected the rights, welfare, and confidentiality of all participants involved. All data were anonymized prior to analysis to ensure participant privacy and confidentiality.

: This study was based on retrospective, anonymized data extracted from the National Electronic Health System. In accordance with institutional and national guidelines, written informed consent for the use of anonymized health records was obtained at the time of patient registration into the system. No identifiable personal information was accessed or recorded in this study.

: The authors declare no competing interests.