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To ensure the protection of participants\u2019 rights, dignity, and welfare, rigorous protocols were implemented to maintain anonymity, safeguard confidentiality, and prioritize voluntary participation. Formal approval for the research was granted by the Biomedical Research Ethics Committee (BMREC) at Damascus University (ID: MD-011024-314). Prior to enrollment, all participants provided written informed consent following a comprehensive explanation of the study\u2019s objectives, procedures, potential risks, and benefits. Emphasis was placed on transparency, with explicit assurances that participants retained the right to withdraw from the study at any time without penalty or consequence.","order":2,"name":"Ethics","group":{"name":"EthicsHeading","label":"Ethics approval and consent to participate"}},{"value":"Not applicable.","order":3,"name":"Ethics","group":{"name":"EthicsHeading","label":"Consent for publication"}},{"value":"The authors declare no competing interests.","order":4,"name":"Ethics","group":{"name":"EthicsHeading","label":"Competing interests"}}],"article-number":"56"}}