Journal of Clinical and Diagnostic Research, ISSN - 0973 - 709X

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Dr Mohan Z Mani

"Thank you very much for having published my article in record time.I would like to compliment you and your entire staff for your promptness, courtesy, and willingness to be customer friendly, which is quite unusual.I was given your reference by a colleague in pathology,and was able to directly phone your editorial office for clarifications.I would particularly like to thank the publication managers and the Assistant Editor who were following up my article. I would also like to thank you for adjusting the money I paid initially into payment for my modified article,and refunding the balance.
I wish all success to your journal and look forward to sending you any suitable similar article in future"

Dr Mohan Z Mani,
Professor & Head,
Department of Dermatolgy,
Believers Church Medical College,
Thiruvalla, Kerala
On Sep 2018

Prof. Somashekhar Nimbalkar

"Over the last few years, we have published our research regularly in Journal of Clinical and Diagnostic Research. Having published in more than 20 high impact journals over the last five years including several high impact ones and reviewing articles for even more journals across my fields of interest, we value our published work in JCDR for their high standards in publishing scientific articles. The ease of submission, the rapid reviews in under a month, the high quality of their reviewers and keen attention to the final process of proofs and publication, ensure that there are no mistakes in the final article. We have been asked clarifications on several occasions and have been happy to provide them and it exemplifies the commitment to quality of the team at JCDR."

Prof. Somashekhar Nimbalkar
Head, Department of Pediatrics, Pramukhswami Medical College, Karamsad
Chairman, Research Group, Charutar Arogya Mandal, Karamsad
National Joint Coordinator - Advanced IAP NNF NRP Program
Ex-Member, Governing Body, National Neonatology Forum, New Delhi
Ex-President - National Neonatology Forum Gujarat State Chapter
Department of Pediatrics, Pramukhswami Medical College, Karamsad, Anand, Gujarat.
On Sep 2018

Dr. Kalyani R

"Journal of Clinical and Diagnostic Research is at present a well-known Indian originated scientific journal which started with a humble beginning. I have been associated with this journal since many years. I appreciate the Editor, Dr. Hemant Jain, for his constant effort in bringing up this journal to the present status right from the scratch. The journal is multidisciplinary. It encourages in publishing the scientific articles from postgraduates and also the beginners who start their career. At the same time the journal also caters for the high quality articles from specialty and super-specialty researchers. Hence it provides a platform for the scientist and researchers to publish. The other aspect of it is, the readers get the information regarding the most recent developments in science which can be used for teaching, research, treating patients and to some extent take preventive measures against certain diseases. The journal is contributing immensely to the society at national and international level."

Dr Kalyani R
Professor and Head
Department of Pathology
Sri Devaraj Urs Medical College
Sri Devaraj Urs Academy of Higher Education and Research , Kolar, Karnataka
On Sep 2018

Dr. Saumya Navit

"As a peer-reviewed journal, the Journal of Clinical and Diagnostic Research provides an opportunity to researchers, scientists and budding professionals to explore the developments in the field of medicine and dentistry and their varied specialities, thus extending our view on biological diversities of living species in relation to medicine.
‘Knowledge is treasure of a wise man.’ The free access of this journal provides an immense scope of learning for the both the old and the young in field of medicine and dentistry as well. The multidisciplinary nature of the journal makes it a better platform to absorb all that is being researched and developed. The publication process is systematic and professional. Online submission, publication and peer reviewing makes it a user-friendly journal.
As an experienced dentist and an academician, I proudly recommend this journal to the dental fraternity as a good quality open access platform for rapid communication of their cutting-edge research progress and discovery.
I wish JCDR a great success and I hope that journal will soar higher with the passing time."

Dr Saumya Navit
Professor and Head
Department of Pediatric Dentistry
Saraswati Dental College
On Sep 2018

Dr. Arunava Biswas

"My sincere attachment with JCDR as an author as well as reviewer is a learning experience . Their systematic approach in publication of article in various categories is really praiseworthy.
Their prompt and timely response to review's query and the manner in which they have set the reviewing process helps in extracting the best possible scientific writings for publication.
It's a honour and pride to be a part of the JCDR team. My very best wishes to JCDR and hope it will sparkle up above the sky as a high indexed journal in near future."

Dr. Arunava Biswas
MD, DM (Clinical Pharmacology)
Assistant Professor
Department of Pharmacology
Calcutta National Medical College & Hospital , Kolkata

Dr. C.S. Ramesh Babu
" Journal of Clinical and Diagnostic Research (JCDR) is a multi-specialty medical and dental journal publishing high quality research articles in almost all branches of medicine. The quality of printing of figures and tables is excellent and comparable to any International journal. An added advantage is nominal publication charges and monthly issue of the journal and more chances of an article being accepted for publication. Moreover being a multi-specialty journal an article concerning a particular specialty has a wider reach of readers of other related specialties also. As an author and reviewer for several years I find this Journal most suitable and highly recommend this Journal."
Best regards,
C.S. Ramesh Babu,
Associate Professor of Anatomy,
Muzaffarnagar Medical College,
On Aug 2018

Dr. Arundhathi. S
"Journal of Clinical and Diagnostic Research (JCDR) is a reputed peer reviewed journal and is constantly involved in publishing high quality research articles related to medicine. Its been a great pleasure to be associated with this esteemed journal as a reviewer and as an author for a couple of years. The editorial board consists of many dedicated and reputed experts as its members and they are doing an appreciable work in guiding budding researchers. JCDR is doing a commendable job in scientific research by promoting excellent quality research & review articles and case reports & series. The reviewers provide appropriate suggestions that improve the quality of articles. I strongly recommend my fraternity to encourage JCDR by contributing their valuable research work in this widely accepted, user friendly journal. I hope my collaboration with JCDR will continue for a long time".

Dr. Arundhathi. S
MBBS, MD (Pathology),
Sanjay Gandhi institute of trauma and orthopedics,
On Aug 2018

Dr. Mamta Gupta,
"It gives me great pleasure to be associated with JCDR, since last 2-3 years. Since then I have authored, co-authored and reviewed about 25 articles in JCDR. I thank JCDR for giving me an opportunity to improve my own skills as an author and a reviewer.
It 's a multispecialty journal, publishing high quality articles. It gives a platform to the authors to publish their research work which can be available for everyone across the globe to read. The best thing about JCDR is that the full articles of all medical specialties are available as pdf/html for reading free of cost or without institutional subscription, which is not there for other journals. For those who have problem in writing manuscript or do statistical work, JCDR comes for their rescue.
The journal has a monthly publication and the articles are published quite fast. In time compared to other journals. The on-line first publication is also a great advantage and facility to review one's own articles before going to print. The response to any query and permission if required, is quite fast; this is quite commendable. I have a very good experience about seeking quick permission for quoting a photograph (Fig.) from a JCDR article for my chapter authored in an E book. I never thought it would be so easy. No hassles.
Reviewing articles is no less a pain staking process and requires in depth perception, knowledge about the topic for review. It requires time and concentration, yet I enjoy doing it. The JCDR website especially for the reviewers is quite user friendly. My suggestions for improving the journal is, more strict review process, so that only high quality articles are published. I find a a good number of articles in Obst. Gynae, hence, a new journal for this specialty titled JCDR-OG can be started. May be a bimonthly or quarterly publication to begin with. Only selected articles should find a place in it.
An yearly reward for the best article authored can also incentivize the authors. Though the process of finding the best article will be not be very easy. I do not know how reviewing process can be improved. If an article is being reviewed by two reviewers, then opinion of one can be communicated to the other or the final opinion of the editor can be communicated to the reviewer if requested for. This will help one’s reviewing skills.
My best wishes to Dr. Hemant Jain and all the editorial staff of JCDR for their untiring efforts to bring out this journal. I strongly recommend medical fraternity to publish their valuable research work in this esteemed journal, JCDR".

Dr. Mamta Gupta
(Ex HOD Obs &Gynae, Hindu Rao Hospital and associated NDMC Medical College, Delhi)
Aug 2018

Dr. Rajendra Kumar Ghritlaharey

"I wish to thank Dr. Hemant Jain, Editor-in-Chief Journal of Clinical and Diagnostic Research (JCDR), for asking me to write up few words.
Writing is the representation of language in a textual medium i e; into the words and sentences on paper. Quality medical manuscript writing in particular, demands not only a high-quality research, but also requires accurate and concise communication of findings and conclusions, with adherence to particular journal guidelines. In medical field whether working in teaching, private, or in corporate institution, everyone wants to excel in his / her own field and get recognised by making manuscripts publication.

Authors are the souls of any journal, and deserve much respect. To publish a journal manuscripts are needed from authors. Authors have a great responsibility for producing facts of their work in terms of number and results truthfully and an individual honesty is expected from authors in this regards. Both ways its true "No authors-No manuscripts-No journals" and "No journals–No manuscripts–No authors". Reviewing a manuscript is also a very responsible and important task of any peer-reviewed journal and to be taken seriously. It needs knowledge on the subject, sincerity, honesty and determination. Although the process of reviewing a manuscript is a time consuming task butit is expected to give one's best remarks within the time frame of the journal.
Salient features of the JCDR: It is a biomedical, multidisciplinary (including all medical and dental specialities), e-journal, with wide scope and extensive author support. At the same time, a free text of manuscript is available in HTML and PDF format. There is fast growing authorship and readership with JCDR as this can be judged by the number of articles published in it i e; in Feb 2007 of its first issue, it contained 5 articles only, and now in its recent volume published in April 2011, it contained 67 manuscripts. This e-journal is fulfilling the commitments and objectives sincerely, (as stated by Editor-in-chief in his preface to first edition) i e; to encourage physicians through the internet, especially from the developing countries who witness a spectrum of disease and acquire a wealth of knowledge to publish their experiences to benefit the medical community in patients care. I also feel that many of us have work of substance, newer ideas, adequate clinical materials but poor in medical writing and hesitation to submit the work and need help. JCDR provides authors help in this regards.
Timely publication of journal: Publication of manuscripts and bringing out the issue in time is one of the positive aspects of JCDR and is possible with strong support team in terms of peer reviewers, proof reading, language check, computer operators, etc. This is one of the great reasons for authors to submit their work with JCDR. Another best part of JCDR is "Online first Publications" facilities available for the authors. This facility not only provides the prompt publications of the manuscripts but at the same time also early availability of the manuscripts for the readers.
Indexation and online availability: Indexation transforms the journal in some sense from its local ownership to the worldwide professional community and to the public.JCDR is indexed with Embase & EMbiology, Google Scholar, Index Copernicus, Chemical Abstracts Service, Journal seek Database, Indian Science Abstracts, to name few of them. Manuscriptspublished in JCDR are available on major search engines ie; google, yahoo, msn.
In the era of fast growing newer technologies, and in computer and internet friendly environment the manuscripts preparation, submission, review, revision, etc and all can be done and checked with a click from all corer of the world, at any time. Of course there is always a scope for improvement in every field and none is perfect. To progress, one needs to identify the areas of one's weakness and to strengthen them.
It is well said that "happy beginning is half done" and it fits perfectly with JCDR. It has grown considerably and I feel it has already grown up from its infancy to adolescence, achieving the status of standard online e-journal form Indian continent since its inception in Feb 2007. This had been made possible due to the efforts and the hard work put in it. The way the JCDR is improving with every new volume, with good quality original manuscripts, makes it a quality journal for readers. I must thank and congratulate Dr Hemant Jain, Editor-in-Chief JCDR and his team for their sincere efforts, dedication, and determination for making JCDR a fast growing journal.
Every one of us: authors, reviewers, editors, and publisher are responsible for enhancing the stature of the journal. I wish for a great success for JCDR."

Thanking you
With sincere regards
Dr. Rajendra Kumar Ghritlaharey, M.S., M. Ch., FAIS
Associate Professor,
Department of Paediatric Surgery, Gandhi Medical College & Associated
Kamla Nehru & Hamidia Hospitals Bhopal, Madhya Pradesh 462 001 (India)
On May 11,2011

Dr. Shankar P.R.

"On looking back through my Gmail archives after being requested by the journal to write a short editorial about my experiences of publishing with the Journal of Clinical and Diagnostic Research (JCDR), I came across an e-mail from Dr. Hemant Jain, Editor, in March 2007, which introduced the new electronic journal. The main features of the journal which were outlined in the e-mail were extensive author support, cash rewards, the peer review process, and other salient features of the journal.
Over a span of over four years, we (I and my colleagues) have published around 25 articles in the journal. In this editorial, I plan to briefly discuss my experiences of publishing with JCDR and the strengths of the journal and to finally address the areas for improvement.
My experiences of publishing with JCDR: Overall, my experiences of publishing withJCDR have been positive. The best point about the journal is that it responds to queries from the author. This may seem to be simple and not too much to ask for, but unfortunately, many journals in the subcontinent and from many developing countries do not respond or they respond with a long delay to the queries from the authors 1. The reasons could be many, including lack of optimal secretarial and other support. Another problem with many journals is the slowness of the review process. Editorial processing and peer review can take anywhere between a year to two years with some journals. Also, some journals do not keep the contributors informed about the progress of the review process. Due to the long review process, the articles can lose their relevance and topicality. A major benefit with JCDR is the timeliness and promptness of its response. In Dr Jain's e-mail which was sent to me in 2007, before the introduction of the Pre-publishing system, he had stated that he had received my submission and that he would get back to me within seven days and he did!
Most of the manuscripts are published within 3 to 4 months of their submission if they are found to be suitable after the review process. JCDR is published bimonthly and the accepted articles were usually published in the next issue. Recently, due to the increased volume of the submissions, the review process has become slower and it ?? Section can take from 4 to 6 months for the articles to be reviewed. The journal has an extensive author support system and it has recently introduced a paid expedited review process. The journal also mentions the average time for processing the manuscript under different submission systems - regular submission and expedited review.
Strengths of the journal: The journal has an online first facility in which the accepted manuscripts may be published on the website before being included in a regular issue of the journal. This cuts down the time between their acceptance and the publication. The journal is indexed in many databases, though not in PubMed. The editorial board should now take steps to index the journal in PubMed. The journal has a system of notifying readers through e-mail when a new issue is released. Also, the articles are available in both the HTML and the PDF formats. I especially like the new and colorful page format of the journal. Also, the access statistics of the articles are available. The prepublication and the manuscript tracking system are also helpful for the authors.
Areas for improvement: In certain cases, I felt that the peer review process of the manuscripts was not up to international standards and that it should be strengthened. Also, the number of manuscripts in an issue is high and it may be difficult for readers to go through all of them. The journal can consider tightening of the peer review process and increasing the quality standards for the acceptance of the manuscripts. I faced occasional problems with the online manuscript submission (Pre-publishing) system, which have to be addressed.
Overall, the publishing process with JCDR has been smooth, quick and relatively hassle free and I can recommend other authors to consider the journal as an outlet for their work."

Dr. P. Ravi Shankar
KIST Medical College, P.O. Box 14142, Kathmandu, Nepal.
On April 2011

Dear team JCDR, I would like to thank you for the very professional and polite service provided by everyone at JCDR. While i have been in the field of writing and editing for sometime, this has been my first attempt in publishing a scientific paper.Thank you for hand-holding me through the process.

Dr. Anuradha
On Jan 2020

Important Notice

Year : 2023 | Month : January | Volume : 17 | Issue : 1 | Page : LE01 - LE04 Full Version

Predictors of Heart Rate Variability: A Systematic Review

Published: January 1, 2023 | DOI:
Rani Jose, Neetha Kamath, Sreeja Gopalakrishnapillai, Salina Sunil

1. Professor, Department of Medical Surgical Nursing, Government Nursing College, Kannur, Kerala, India. 2. Associate Professor, Department of Community Health Nursing, NITTE Usha Institute of Nursing Sciences/NITTE Deemed to be University, Mangalore, Karnataka, India. 3. Professor, Department of OBG Nursing, Government Nursing College, Kannur, Kerala, India. 4. Associate Professor, Department of Community Health Nursing, College of Nursing, Thalassery, Kerala, India.

Correspondence Address :
Dr. Neetha Kamath,
Kotekar Beeri Road, Paneer, Deralakatte, Mangalore, Karnataka, India.


Introduction: The heart has the ability to maintain cardiac output in accordance with the body’s momentarily changing demands by adjusting its rate of contractions and this ability is termed Heart Rate Variability (HRV), which is manifested as a fluctuation of R-R interval in milliseconds on an Electrocardiography (ECG). Maintenance of good HRV levels is significant for the patient population since they influence the prognosis and quality of life.

Aim: To identify the predictors of HRV.

Materials and Methods: The present study was a systematic and literature review which was based on Preferred Reporting Items for Systematic reviews and Meta-Analysis (PRISMA) guidelines 2020. Randomised Controlled Trials (RCTs) published in English from 2014 to 2021 were identified from Cochrane Library, Science Direct, PubMed, and Google Scholar databases. The keywords with Boolean operators were used as “influencing factors or determinants or predictors and HRV.” The quality assessments of the studies were performed with Cochrane risk-of-bias assessment tool. Narrative syntheses upon the selected studies were done.

Results: The significant findings from the nine selected RCTs were summarised. Physical exercise, breathing exercise, diet, music, and mind-body interventions such as yoga and meditation were identified as the factors enhancing HRV or predictors of HRV.

Conclusion: The findings of this systematic review strive to facilitate healthcare providers to devise the strategies to support the risk group of low HRV by the implementation of enhancing factors of HRV to achieve a better outcome.


Determinants, Exercises, Influencing factors

The heart is a unique organ with a capacity to maintain cardiac output in accordance with the body’s momentarily changing demands by adjusting its rate of contractions. This ability is termed HRV, manifested as a fluctuation of R-R interval in milliseconds on an ECG. A person with high HRV can be considered healthy in terms of physical, social, mental, and spiritual aspects. Measurement and maintenance of good HRV levels are significant for the patient population since they influence the prognosis and quality of life (1). The heart rate is modulated by a balance between the sympathetic and parasympathetic systems. The neuro-cardiac function reflects the interaction between the heart and brain, measured by the HRV. Hence, researchers and clinicians worldwide use HRV to measure the heart’s autonomic control (2). HRV is an emerging concept in the field of medical treatment, and the available empirical data on the factors affecting HRV are scattered. Many factors can influence HRV. Several studies were conducted to identify, the influence of individual factors on HRV. According to a review, physiological, pathological, neuropsychological, lifestyle, and environmental factors can influence HRV (3). The studies involving a compilation of the factors which can enhance HRV may facilitate the healthcare providers to devise strategies to support the risk group of low HRV. The enhancement of HRV is directly related to Parasympathetic Nervous System (PNS) activation (4). This systematic review addresses the research question, that what are the factors enhancing HRV. The main objective was to identify the positive predictors of HRV.

Material and Methods

Search Strategy

The review followed the guidelines of PRISMA 2020 (5). The Prospero Id for the review was registered as CRD42021270016. The steps for conducting the systematic review comprised locating the sources, selecting the studies, and quality appraisal of studies, followed by the presentation of findings. A systematic review of literature for articles in the English language, published from 2014 to 2021, was conducted using electronic databases such as Cochrane Library, Science Direct, PubMed, and Google Scholar. The keywords used for the search were “influencing factors”, “HRV” combined with Boolean operators “AND” and “OR” with the synonyms “determinants” and “predictors”. In addition to the above, a reference list of all relevant articles and reviews was checked.

Inclusion criteria

• Type of study- RCTs published between 2014-2021
• Language-English
• Study participants-Adults of both gender aged above 18 years
• Full-text article availability.

Exclusion criteria

Articles on-

• Paediatric population,
• Pregnant and lactating mothers.

After identifying the records through databases and reference lists, duplicates were removed manually. Two levels of screening were completed independently by three authors, the first level was the screening of title and abstracts, and the second level was the full-text screening of eligible studies. Disagreements concerning article inclusion were resolved within the group discussion. Three reviewers worked independently to reduce the chance of error, add more scrutiny, and ensure proper conduct.

The literature search in various databases and reference list of other relevant articles yielded 360 studies. After excluding 15 duplicates, there were 345 articles, of which 288 articles that were not relevant based on the selection criteria were excluded, and the remaining 57 records were identified for screening. Another 44 studies were also eliminated as they had multiple outcome measures other than factors influencing HRV. A risk-of-bias assessment screening was done for the remaining 13 records, and four studies were eliminated. Ultimately, nine studies were considered for data synthesis. The study selection process is depicted in PRISMA (Table/Fig 1) (5).

Quality Assessment and Data Extraction

The methodological qualities of the studies were evaluated independently by two authors. An assessment of the ‘risk-of-bias’ was done using the Cochrane risk-of-bias assessment tool for randomised trials (6). The tool categorises the risk as high, low, or uncertain according to the description of the study with reference to the methodology. The researchers compared the scores after they were measured independently by the researchers (Table/Fig 2) (7),(8),(9),(10),(11),(12),(13),(14),(15),(16),(17),(18),(19).

Three reviewers extracted data using a predesigned data extraction sheet to allow standardised reporting of results across studies.


The study characteristics extracted from each review were as follows: Basic information of the study, including the year of publication, author, participants, interventions, and outcome (Table/Fig 3) (7),(10),(11),(13),(14),(15),(16),(18),(19).

As the studies included were heterogeneous in outcome measures, a narrative synthesis of the data was conducted. The significant findings from the nine selected RCTs were summarised. Physical exercise, breathing exercise, diet, music, and mind-body interventions such as yoga and meditation were identified as the factors enhancing HRV or predictors of HRV (Table/Fig 4) (7),(10),(11),(13),(14),(15),(16),(18),(19).


HRV is the outcome of the dynamic interaction of various body systems. It is now used as a standard indicator of health. Understanding the following influencing factors of HRV helps healthcare providers in their daily practice in different clinical contexts (2). Physical exercises such as combined aerobic and resistance training (10), water exercises (11), stretching (13), and interval training (16) enhance HRV. Exercise duration between 6-24 weeks, for atleast three times per week, is sufficient to influence HRV positively (20). A systematic review identified interval training as an efficient method for cardiorespiratory variables. The acute stretching exercise was a helpful therapeutic intervention to improve cardiac autonomic function in different populations (21). Walking is associated with enhanced PNS activity and improved HRV (22),(23).

The frequency and amplitude of respiration modulate the pattern of heart rhythm known as respiratory sinus arrhythmia. So, cognitively directed breathing exercises can highly influence HRV in a positive manner (7),(15),(19). An experimental study identified the influence of metronome breathing upon HRV with age and postural variations. HRV and respiratory sinus arrhythmia were promoted by breathing techniques paralleled by central nervous system activity modifications. A slow breathing technique was indicated by an increase in alpha and a decrease in theta power during EEG monitoring (24). Many sources of stress, such as anxiety, hostility, depression, work stress, and negative emotions, induce low HRV. Mind body interventions such as mindfulness meditation, yoga, qigong/tai chi, etc., improve HRV by increasing parasympathetic tone (3),(15),(25),(26).

The literature also identified the positive influence of compassionate care on HRV (27),(28). In a thesis, it is identified that forgiveness improves HRV, and forgiveness influences physical health through mechanisms of cardiac autonomic control ((29)-unpublished, waiting to be published). A randomised pilot study revealed that gratitude journaling improves parasympathetic HRV responses (30). As per a review, a moderate-fat diet containing pistachios improves the measures of HRV (18). Another review explains that the mediterranean diet, omega-3 fatty acids, B vitamins, probiotics, and polyphenols enhance HRV. In a cross-sectional study, wine intake was associated with increased HRV.

3On the other hand, the consumption of beer and spirits and the total amount of alcohol consumed did not relate significantly to the HRV parameters (31),(32). Another systematic review identified that music benefits the cardiovascular system (33). Hence, with music therapy, HRV can be increased, and there will be reduced sympathetic activation.

The clinical implementation of this systematic review finding was significant for a holistic approach to patient care. In light of this, it may be suggested that an intervention comprising positive predictors of HRV be developed and an extensive prospective evaluation of the intervention should be conducted.


In this review, a formal meta-analysis was not considered appropriate due to the considerable variations in the analysed HRV parameters and assessment contexts (e.g., short term versus long-term recordings of HRV).


Keeping an elevated HRV level plays a significant role in a person’s personal and social life. It contributes much to his/her physical, mental, social, and spiritual well-being. The findings of this systematic review strive to facilitate healthcare providers and devise strategies to support the risk group of low HRV and to achieve a better outcome.


The authors would like to thank Mrs. Leena Sooraj for editing the manuscript.


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DOI and Others

DOI: 10.7860/JCDR/2023/57454.17270

Date of Submission: Jun 21, 2022
Date of Peer Review: Aug 25, 2022
Date of Acceptance: Nov 26, 2022
Date of Publishing: Jan 01, 2023

• Financial or Other Competing Interests: None
• Was informed consent obtained from the subjects involved in the study? NA
• For any images presented appropriate consent has been obtained from the subjects. NA

• Plagiarism X-checker: Jun 22, 2022
• Manual Googling: Nov 21, 2022
• iThenticate Software: Nov 24, 2022 (15%)

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