It is written several times that they have approval of ethical committee and also lot of past tense.
"During an attack phase SAA, CRP, and ESR were obtained. The study was
approved by the local ethical committee, and all participant consent forms were
gathered. ELISA kits were used to estimate SAA. CRP (screened by latex
agglutination test and confirmed by nephelometry analysis) and ESR were
measured. "
In addition the Gantt chart clearly show show that sampling starts 1/4/2025
Is it a re-submition or paper for already approved project ? not clear