Asymptomatic Bacteriuria Group Research Articles

Bacteriological profile, antimicrobial susceptibility, and factors associated with urinary tract infection in pregnant women.

Urinary tract infection (UTI) is a common bacterial complication in pregnancy. The study aimed to estimate the prevalence, risk factors, and bacterial etiology of UTI during pregnancy and determine the efficacy of antimicrobial drugs in treating UTIs. Urine specimens and clinical data were collected from pregnant women who attended primary health centers in Erbil, Iraq. All specimens were cultured on appropriate media and identified by standard microbiological methods. The pregnant women were grouped into symptomatic UTI group, asymptomatic bacteriuria group, and the control group. The agar dilution method was used to determine antimicrobial susceptibility. Among the 5,042 pregnant women included in this study, significant bacteriuria was found in 625 (12.40%) of the cases, and 198 (31.68%) had symptomatic UTI, of which 43.59% were diagnosed during the third trimester. Out of the 643 bacteria isolated, 33.28% were symptomatic UTI, of which 43.59% developed during the third trimester. There was a significant difference in the bacterial etiology between symptomatic UTI and asymptomatic bacteriuria (p = 0.002), as well as between cystitis and pyelonephritis (p = 0.017). The most common bacterial species isolated was Escherichia coli, which was susceptible to fosfomycin (100%), meropenem (99.45%), and nitrofurantoin (97.8%). Pregnant women are more likely to develop UTI in the third trimester. Escherichia coli is the predominant pathogen. The study suggests the use of fosfomycin, meropenem, and nitrofurantoin for the treatment of UTI. No Gram-positive isolates were resistant to daptomycin.

Screening of asymptomatic bacteriuria in children with sickle cell disease

Abstract Background Asymptomatic bacteriuria (ASB) refers to two consecutive urine cultures growing more than 100 000 CFU/ml in a patient with no symptoms of urinary tract infection. In patients with sickle cell disease (SCD), the anatomical and physiological defects make ASB more prone to worsen the sickle nephropathy. Early detection and management of ASB in children with SCD may retard this progression. Aim To investigate the prevalence of ASB, its major determinants, and its effect on kidney functions in patients with SCD for early detection and treatment. Patients and methods The study was conducted at a children’s hospital during the period between June 2019 and February 2020. The study included 30 children previously diagnosed as having SCD. Midstream urine samples were collected twice from all patients and subjected to urinalysis and culture on chromogenic media. Only significant isolates were identified and subjected to antimicrobial susceptibility testing. Patients were divided into either ASB or sterile urine group. All patients with SCD were subjected to complete blood picture, reticulocytic count, markers of hemolysis, and serum creatinine. Results The prevalence of confirmed ASB was 16.7%. All children in ASB group had pyuria (100%). Staphylococcus saprophyticus (60%) was the commonest organism isolated, followed by Escherichia coli (20%) and Klebsiella pneumoniae (20%). Sulfamethoxazole+trimethoprim was the most sensitive antibiotic among all isolated microorganisms. The differences in kidney function results between the two groups were statistically insignificant. Conclusion ASB was of high prevalence in pediatric patients with SCD in Egypt at our hospital. Pyuria was the only major determinant. S. saprophyticus was the predominant organism. Serum creatinine was a nonsensitive marker to monitor kidney functions.

Knowledge Discovery-Based Analysis of Health Factors of Urinary Infections in Elderly Cardiology Inpatients.

A set of semantic similarity calculation methods combining full-text text and domain knowledge topics is proposed for the current study of entity association relations such as disease–gene in medical texts combined with topics in knowledge discovery, which is insufficient to reveal the deep semantic association relations of medical domain knowledge at topic level. Taking urinary infections in elderly inpatients as the research subject, word embedding representation of word vectors and topic vectors is performed by the TWE model, and similarity calculation is performed by combining text and domain knowledge topics based on Siamese Network framework. The urinary microbiological culture results of both groups were dominated by Escherichia coli, accounting for 34.65% and 47.92%, respectively; the use of antimicrobial drugs in the symptomatic urinary infection group was 94.19% higher than that in the asymptomatic bacteriuria group, 77.27% (x2 = 8.158, P=0.004).

The necessity of treating asymptomatic bacteriuria with antibiotics in the perioperative period of joint arthroplasty: a metaanalysis

Background/aimOral antibiotics are usually used to treat asymptomatic bacteriuria during the perioperative period of joint replacement. However, there is no unified conclusion as to whether asymptomatic bacteriuria causes infection around joint prostheses, and the efficacy of antibiotics is unknown.Materials and methodsWe systematically searched PubMed, CNKI, Ovid, Cochrane Library, EMBASE, manual research, and references of relevant articles up to January 1, 2020, to identify and compare observational studies. The Cochrane systematic review method was used, and Review Manager 5.3 software was used for analysis.ResultsNine articles were included in the analysis, involving 29,844 cases of joint arthroplasty and 2366 cases of asymptomatic bacteriuria. Periprosthetic joint infection had a significantly higher incidence in the asymptomatic bacteriuria group than in the nonasymptomatic bacteriuria group (Odds Ratio: OR = 3.15, 95% CI: 1.23–8.02, P = 0.02). Seven of the nine articles reported the use of antibiotics for treating perioperative asymptomatic bacteriuria and there was no significant difference in the incidence of periprosthetic joint infection between the two groups (OR = 1.64, 95% CI: 0.84–3.23, P = 0.15). ConclusionThe occurrence of asymptomatic bacteriuria in the perioperative period of joint arthroplasty is a risk factor for periprosthetic joint infection, and the use of antibiotics for asymptomatic bacteriuria does not change the rate of incidence.

Epidemiology of Nephrostomy Tube–Related Urinary Tract Infections Among US Veterans

Objective The aim of this study was to review the incidence of asymptomatic bacteriuria (AB) and pyelonephritis after placement of percutaneous nephrostomy tube (NT) in our patients. Methods We retrospectively reviewed patients who underwent NT placement from January 1, 2005, to December 31, 2015, at Northport Veterans Affairs Medical Center. We identified patients with NT-associated AB and NT-related pyelonephritis within 60 days following NT placement. We analyzed demographic data, medical history, and microbiological data. Results Seventy-one patients underwent NT placement. Indications for NT placement included intrinsic obstruction (34%) and extrinsic obstruction (66%). Prostate and urinary bladder cancers were the most common causes of extrinsic obstruction. Twenty percent (14/71) had pyelonephritis, and 24% (17/71) had AB. All patients were men, and median age was 73 years. In the pyelonephritis group, Pseudomonas aeruginosa (36%) and Enterococcus faecalis (35%) were most commonly isolated. Three cases of extended-spectrum β-lactamase–producing Enterobacteriaceae and 2 multiple drug–resistant gram-negative organisms were identified. In the AB group, P. aeruginosa (23%), Enterococcus species (23%), and coagulase-negative staphylococci (23%) were most common. Only 1 case of extended-spectrum β-lactamase organism was identified. Comparing the 2 groups, there was no difference in age (P = 0358), diabetes mellitus (P = 0.441), chronic kidney disease (P = 0.6705), and prior urinary tract infection (P = 1.000). Presence of ureteral stent was seen more in AB (P = 0.057). Conclusions Nephrostomy tube placement was associated with pyelonephritis and AB in 44% of cases overall. Pseudomonas and Enterococcus species were the most common pathogens. Isolation of resistant organisms was mostly observed in the pyelonephritis group.

Pre-operative asymptomatic bacteriuria: a risk factor for prosthetic joint infection?

Infection is a rare complication following implantation of prosthetic material into a joint. The impact of asymptomatic bacteriuria (ASB) before elective operations and the subsequent risk of prosthetic joint infection (PJI) are not well understood. To assess the prevalence of ASB amongst patients undergoing total arthroplasty of the hip and knee; and to determine the rates of PJI diagnosed within two years of the arthroplasty and if ASB is an independent risk factor for developing PJI. Patients who had total/unicondylar knee or total hip arthroplasty were reviewed retrospectively over a five-year period. Pre-operative urine samples within one year of surgery were analysed, and those with ASB were identified. The primary outcome was PJI within the first postoperative year. In total, 5542 patients were included. Of these, 4368 had a pre-operative urine culture recorded. The prevalence of ASB was 140 of 4368 (3.2%). The overall PJI rate was 56 of 5542 (1.01%). Of those with PJI, 33 had a pre-operative urine sample recorded. The infection rates were 5% (seven of 140) in the ASB group, 0.61% (26 of 4228) in the no-ASB group and 1.96% (23 of 1174) in the group without a urine sample (P<0.001). The ASB isolate was the same micro-organism as the PJI isolate in one of the seven cases. The association between ASB and PJI is statistically significant, but the urine isolates did not relate to the isolates in the prosthetic joint, suggesting that the relationship is unlikely to be causal.

Is Preoperative Assessment and Treatment of Asymptomatic Bacteriuria Necessary for Reducing the Risk of Postoperative Symptomatic Urinary Tract Infections After Urologic Surgical Procedures?

To evaluate whether it is always necessary to test for the presence of asymptomatic bacteriuria (AB) in patients undergoing urologic surgical procedures, and if present, whether to treat AB with antimicrobial prophylaxis. All patients who underwent urologic surgical procedures from December 2008 to October 2013 in a tertiary referral urologic center were considered for this study. All patients received antimicrobial prophylaxis in line with European Association of Urology guidelines on urologic infections. AB was diagnosed if ≥105 colony-forming units/mL were cultured. The population was subdivided into 2 groups: group A, patients with preoperative AB, and group B, patients without AB. Data on postoperative symptomatic urinary tract infections (UTIs) were compared for the 2 groups. A total of 2201 patients were considered eligible for this study and were analyzed; 668 (30.4%) patients were found to harbor AB (group A), and 1533 (69.6%) patients did not have AB (group B). Microbiologically verified symptomatic postoperative UTIs occurred in 198 patients (8.9%). No difference in terms of overall rate of postoperative symptomatic UTI was found between the 2 groups (group A: 70 [10.4%] and group B: 128 [8.3%]; OR: 1.28 95%CI 0.94-1.74; P = .12), as well as in terms of urosepsis (group A: 2 [0.30%] and group B: 4 [0.26%]; P = 1.0). In patients undergoing urologic surgical procedures who are receiving antimicrobial prophylaxis in accordance with European Association of Urology guidelines, the preoperative presence of AB in this study was not associated with a higher incidence of postoperative symptomatic UTI.

Is asymptomatic bacteriuria a risk factor for prosthetic joint infection?

Infection is a major complication after total joint arthroplasty. The urinary tract is a possible source of surgical site contamination, but the role of asymptomatic bacteriuria (ASB) before elective surgery and the subsequent risk of infection is poorly understood. Candidates for total hip or total knee arthroplasty were reviewed in a multicenter cohort study. A urine sample was cultured in all patients, and those with ASB were identified. Preoperative antibiotic treatment was decided on an individual basis, and it was not mandatory or randomized. The primary outcome was prosthetic joint infection (PJI) in the first postoperative year. A total of 2497 patients were enrolled. The prevalence of ASB was 12.1% (303 of 2497), 16.3% in women and 5.0% in men (odds ratio, 3.67; 95% confidence interval, 2.65-5.09; P < .001). The overall PJI rate was 1.7%. The infection rate was significantly higher in the ASB group than in the non-ASB group (4.3% vs 1.4%; odds ratio, 3.23; 95% confidence interval, 1.67-6.27; P = .001). In the ASB group, there was no significant difference in PJI rate between treated (3.9%) and untreated (4.7%) patients. The ASB group had a significantly higher proportion of PJI due to gram-negative microorganisms than the non-ASB group, but these did not correlate to isolates from urine cultures. ASB was an independent risk factor for PJI, particularly that due to gram-negative microorganisms. Preoperative antibiotic treatment did not show any benefit and cannot be recommended.

Outcome of Pregnancy Complicated by Asymptomatic Bacteriuria

Objective: To evaluate pregnancy outcome in women with asymptomatic bacteriuria (ASB). Design: Prospective cohort study. Setting: The University Teaching Hospital Yaounde (Cameroon) from May 1st, 2012 to April 30th, 2014. Population: Fifty two women with (treated) ASB and 156 without ASB were followed up till delivery. Methods: Data were analyzed using Epi-info 3.5.4. Data of women with ASB were compared to those of women without ASB. Fisher's exact test and t-test were used for comparison. P<0.05 was considered statistically significant. Main outcome measures: Maternal age and parity, bacteria isolated from urine culture and its sensitivity, gestational age (GA) at diagnosis of ASB and at delivery, maternal complication during pregnancy, fetal sex and the birth weight. Results: The mean GA at diagnosis of ASB was 21.0 ± 7.0 weeks. The main micro-organism isolated was Escherichia coli. The two antibiotics usually efficient were ceftriaxone and amoxicillin-clavulanic acid. There was no significant differences regarding maternal age, parity or the mean GA at delivery in both groups. ASB was associated with preterm birth (RR 2.4) and especially with low birth weight (LBW:<2500 g) (RR 5), especially when diagnosed early in pregnancy (RR 7.4). No case of pre eclampsia or pyelonephritis was observed in the ASB group. Conclusion: ASB is associated with LBW especially when present early in pregnancy.

Virulence factors of uropathogenic Escherichia coli of urinary tract infections and asymptomatic bacteriuria in children

The clinical aspects of virulence genes of uropathogenic Escherichia coli (UPEC) are not fully understood. This study compared the presence of virulence genes in UPEC isolated from urinary tract infections (UTIs) and asymptomatic bacteriuria (ABU) in children. The study included children with UTI (n = 15) or ABU (n = 49) treated at Chung-Ang University Yongsan Hospital between 2010 and 2011. The strains were acquired from each urine sample collected, and 18 major virulence genes were detected by polymerase chain reaction. Antimicrobial susceptibility of all UPEC isolates was determined. Sixty-four E. coli strains were isolated from the urine samples. The most commonly identified virulence gene in both groups was fimH (100.0% in the UTI group and 95.9% in the ABU group). The UTI isolates showed a higher prevalence of papEF and fyuA, and a lower prevalence of feoB than ABU isolates (p < 0.01 for all). The profile of virulence gene, fimH(+)kpsMTII(+)feoB(+) also showed a significant difference between the two groups (p < 0.01). Isolates from ABU were more resistant to most antimicrobials tested. The presence of papEF, feoB, and fyuA also correlated with the antimicrobial susceptibility of UPEC. The virulence gene repertoire was different in the UPEC of UTI and ABU. The papEF, feoB, and fyuA genes showed meaningful differences between the two groups and may have an important role in the pathogenesis of overt UTI.

Increased serum procalcitonin levels in pregnant patients with asymptomatic bacteriuria

BackgroundAmong the pregnancy urinary tract infections, asymptomatic bacteriuria (ASB) is the most common one. Untreated ASB can progress to pyelonephritis in 30-50% of the patients and can also result in prematurity in 27% of the pregnancy so it needs immediate diagnosis and treatment. In this study, we wanted to evaluate procalcitonin levels, compared to other inflammatory in pregnant women with ASB.MethodsThe study was designed between the period of January 2012 and February 2013 at Sakarya University School of Medicine, Department of Gynecology and Obstetrics. The study population included 30 pregnant patients with asymptomatic bacteriuria and 39 healthy pregnant controls.ResultsMean age was 28 (SD, 5.5) of the study population; mean maternal weight was 70 (SD, 8) kilogram. There were no statically significant differences between the groups according to the routine biochemical parameters, but gestational age was significantly lower in the ASB group compared to the controls (20.4 vs 28.6, respectively; p < 0.001). Serum procalcitonin levels were negative in all of the controls. In ASB group, 9 (30%) patients had procalcitonin levels greater than >0.05 ng/ml and 21(70%) patients had negative procalcitonin levels (Chi-squrae, p < 0.001). The sensitivity and specificity of procalcitonin assay for ASB was calculated as 30% and 100%, respectively. The positive predictive value was 100% and the negative predictive value was 65%. The most frequent microorganisms in the urine culture were Escherichia coli (26 patients, 87%), Proteus mirabilis (3 patients, 10%) and Klebsiella (1 patient, 3%) in the ASB group. We experienced four (44%) recurrences among nine positive procalcitonin in ASB patients after completion of treatment of the first ASB diagnosis.DiscussionProcalcitonin levels were significantly higher in ASB group than the control group and serum procalcitonin levels were higher in pregnant women with recurrent ASB. This finding is an important result revealed that high procalcitonin level can predict the further urinary tract infection risk. Finally, serum procalcitonin levels were normal in healthy pregnant women while other inflammatory markers such as WBC, ESR and CRP levels were higher.

Cytokines in urine in elderly subjects with acute cystitis and asymptomatic bacteriuria

Objective. Searching for useful diagnostic tools to discriminate between asymptomatic bacteriuria (ASB) and acute cystitis, this study compared urinary levels of cytokines/chemokines and leukocyte esterase in three groups of elderly subjects; those with acute cystitis, those with ASB, and those without bacteriuria. Design. Comparative laboratory. Setting. Primary care. Subjects. A total of 16 patients with acute cystitis, 24 subjects with ASB, and 20 controls without bacteriuria, all of whom were aged 80 or over. Main outcome measures. Urinary levels of IL-1β, TNF-α, IL-12, IL-18, CXCL1 (GRO-α), CXCL8 (IL-8), CCL2 (MCP-1), IL-6, IL-10, and leukocyte esterase. Results. Urinary levels of CXCL1, CXCL8, and IL-6 were significantly higher in acute cystitis patients than in the ASB group. The sensitivities and specificities for CXCL8, IL-6, and leukocyte esterase to discriminate between acute cystitis and ASB were 63% (95% CI 36–84) and 96% (95% CI 77–100) (cut-off > 285 pg/mg creatinine), 81% (95% CI 54–95) and 96% (95% CI 77–100) (cut-off > 30 pg/mg creatinine), and 88% (95% CI 60–98) and 79% (95% CI 57–92) (cut-off > 2, on a scale of 0–4), respectively. Conclusions. The results indicate that measurement of urinary cytokines, and also leukocyte esterase, when using a cut-off value > 2, could be useful in clinical practice to discriminate between symptomatic and asymptomatic urinary tract infections in the elderly. A combination of IL-6 and leukocyte esterase could be even more useful. This needs to be evaluated in prospective studies on the diagnosis and treatment of urinary tract infections in an elderly population.

Mellowing out: adaptation to commensalism by Escherichia coli asymptomatic bacteriuria strain 83972.

UTIs, E. COLI ABUs, AND UPEC Mucosal surfaces in the intestinal, respiratory, and urogenital tracts are populated by a highly diverse bacterial flora. Most host-dwelling bacteria are commensals and maintain a symbiotic relationship with the host; however, a minority are pathogens that attack the mucosa, causing tissue damage and disease symptoms. Bacterial pathogens differ from commensals by the expression of specific virulence factors, such as those that mediate tissue assault. Commensals, in contrast, have generally been regarded as bacteria lacking such virulence factors or other specific mechanisms for interaction with host tissues. Asymptomatic carriage of bacteria may also result after a primary symptomatic infection. However, this type of carrier state differs from commensalism in that variants of pathogenic strains persist without evoking a host response. This review is focused on the molecular basis for attenuation of virulence and adaptation to commensalism, using the prototypic asymptomatic bacteriuria strain Escherichia coli 83972 as a model. Most E. coli strains coexist peacefully with their human host, while others cause disease. E. coli is a versatile pathogen causing a spectrum of diseases, including urinary tract infections (UTIs), diarrhea, sepsis, and meningitis (28). UTIs are among the most common infectious diseases of humans and are a major cause of morbidity. It is estimated that 40 to 50% of healthy adult women have experienced at least one UTI episode (15). Acute pyelonephritis and asymptomatic bacteriuria (ABU) represent the two extremes of UTI. Escherichia coli is responsible for 80% of UTIs. Acute pyelonephritis is a severe acute systemic infection caused by uropathogenic E. coli (UPEC) clones with virulence genes clustered on “pathogenicity islands” (13, 16, 25, 46, 67, 72). ABU, on the other hand, is an asymptomatic carrier state that resembles commensalism. Paradoxically, a large proportion of UTIs are caused by ABU E. coli. Individuals infected with ABU group E. coli may carry high urine titers of a single E. coli strain for months or years without provoking a host response. According to conventional notions, pathogens can develop from commensals by the acquisition of virulence-associated genes located on, for example, pathogenicity islands or plasmids. The flip side of this evolutionary force is the equally important adaptation of the newly minted pathogen to its new host niche, where genes are inactivated by either point mutation, insertion, or deletion (39). Here we illustrate such an example, where the commensal-topathogen shift in E. coli is bidirectional.

Urine Cytokines Profile in Renal Transplant Patients with Asymptomatic Bacteriuria

The role of asymptomatic bacteriuria in kidney transplant recipients is unknown. There is no clear evidence of its effect on transplanted kidney. We studied urine cytokines profile among kidney transplant recipients with bacteriuria found in screening examination. Urine cultures were collected in 269 patients with stable graft function and serum creatinine level <2 mg/dl, during their routine visits. Interleukin (IL)-6 and IL-8 levels were measured in urine samples from patients with asymptomatic bacteriuria, symptomatic urinary tract infection and patients without bacteriuria (control group). Changes in serum creatinine level in patients with asymptomatic bacteriuria and in the control group were observed during 12 months follow up. Urinary tract infection (UTI) was diagnosed in five patients and asymptomatic bacteriuria in 22 patients. Urine IL-6 level was significantly higher in symptomatic UTI group (median 15.71 pg/mg) but there were no differences between group of patients with asymptomatic bacteriuria (3.92 pg/mg) and control group (2.54 pg/mg). Urine IL-8 level was higher in symptomatic UTI group (median 146.8 pg/mg) and was also significantly higher in asymptomatic bacteriuria group (33.49 pg/mg) in comparison to control group (2.97 pg/mg; P=0.0002). During 1-year follow up, incidence of UTI was higher in the asymptomatic bacteriuria group than in the control group but graft function was not different in both groups. Elevated urine IL-8 level in kidney transplant patients with asymptomatic bacteriuria may reflect impaired immune response to bacterial infection and occult inflammatory process in urinary tract.

Frequency and Organization of pap Homologous DNA in Relation to Clinical Origin of Uropathogenic Escherichia coli

The pap operon encodes the gal alpha 1-4gal beta specific adhesins of Escherichia coli. The presence and organization of pap homologous DNA was determined using two probes specific for pap in 217 uropathogenic E. coli samples by dot blot and Southern blot analysis. The frequency of pap homologous DNA was 76% in pyelonephritis, 69% in cystitis, and 52% in an asymptomatic bacteriuria group. Further, the gal alpha 1-4gal beta binding phenotype among the pap-positive strains was expressed more often in acute pyelonephritis (91%) than the cystitis (60%) or asymptomatic bacteriuria (52%) strains. This was explained in part by difference in organization of pap homologous DNA between the genotypically positive pyelonephritis and asymptomatic bacteriuria strains. The pyelonephritis isolates contained three copies of pap significantly more often than the asymptomatic bacteriuria strains, and the pyelonephritogenic O-antigen types had a general increase in pap copy number. The difference in expression of gal alpha 1-4gal beta adhesins between pyelonephritis and asymptomatic bacteriuria isolates was thus not only a function of the frequency of pap homologous DNA but also of phenotypic expression among genotypically pap-positive strains.

Asymptomatic Bacteriuria—A Long-Term Study

AbstractFour percent of the women in a population study 1969-1970 had asymptomatic bacteriuria (ABU). 15 years later a reinvestigation was carried out, in women born 1913-1948. 40 women with ABU and 40 age-matched healthy controls from the population study participated. The frequency of symptomatic urinary tract infections (UTI) had been significantly higher in the ABU group than in the control group during follow-up, but nobody had developed progressive renal disease. Three women in the ABU group and one in the control group had low urine concentrating capacity. All other osmolality values were within normal limits, although there was a significant difference between the two groups. The age-dependent decrease after 15 years was the same in both groups. The number of new hypertensives was the same in both groups. A total of 37.5% were hypertensive in the ABU group and only 12.5% in the control group, but as hypertension had been excluded in the control group at the first investigation the groups could not...

Asymptomatic bacteriuria--a long-term study.

Four percent of the women in a population study 1969-1970 had asymptomatic bacteriuria (ABU). 15 years later a reinvestigation was carried out, in women-born 1913-1948. 40 women with ABU and 40 age-matched healthy controls from the population study participated. The frequency of symptomatic urinary tract infections (UTI) had been significantly higher in the ABU group than in the control group during follow-up, but nobody had developed progressive renal disease. Three women in the ABU group and one in the control group had low urine concentrating capacity. All other osmolality values were within normal limits, although there was a significant difference between the two groups. The age-dependent decrease after 15 years was the same in both groups. The number of new hypertensives was the same in both groups. A total of 37.5% were hypertensive in the ABU group and only 12.5% in the control group, but as hypertension had been excluded in the control group at the first investigation the groups could not be compared in this respect.