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All participants provided written informed consent after being fully informed about the study's objectives, procedures, and potential risks. Confidentiality of information and participants' rights were fully protected. In case of any adverse events or discomfort, appropriate care was provided, and participants were free to withdraw from the study at any time. This clinical trial was registered in the Iranian Registry of Clinical Trials (IRCT) under the registration number IRCT20210926052594N1 (Registration date: 2021-10-09). All procedures performed in this study were conducted in accordance with the ethical standards of the institutional and national research ethics guidelines of Iran, and with the 1964 Declaration of Helsinki and its later amendments or comparable ethical standards. Ethical standards for publication were followed, including accurate translation and citation of all sources. 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