Ethical approval and consent to participate
The study protocol conformed to the ethical guidelines of the 1975 Declaration of Helsinki and was reviewed and approved by the ethics subcommittee of King Saud University, Riyadh, Saudi Arabia, under file ID RRC-2019-14, dated 22-04-2019. In addition, the Institutional Ethical Committee at Manav Rachna International Institute of Research & Studies approved the study protocol under reference number EC/2023-24/033, since the participants included patients visiting the OPD. Each participant was asked to submit a signed informed consent form as proof of consent to participate in the study. To ensure transparency and accountability, the study protocol was registered in the clinical trial registry at 