Ethics approval and consent to participate
Ethical approval was obtained from the Local Research Ethics Committee Approval which was acquired from the University of Damascus (UDDS-588-2018GD/SRC-57782). All procedures performed in studies involving human participants were in accordance with the ethical standards of the institutional and/or national research committee and with the 1964 Helsinki declaration and its later amendments or comparable ethical standards. Written informed consent was obtained from each participant in this study.