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    "textoCompleto" => "<span class="elsevierStyleSections"><p id="par0005" class="elsevierStylePara elsevierViewall">In Brazil there are few published studies on the reference values of maximal respiratory pressures&#46; The first publication was written by Camelo Jr et al&#46;&#44;<a class="elsevierStyleCrossRef" href="#bib0030"><span class="elsevierStyleSup">1</span></a> who&#44; in 1985&#44; was a pioneer in the field by suggesting maximal inspiratory &#40;MIP&#41; and expiratory &#40;MEP&#41; pressure values for the Brazilian adult population&#46; A few years later&#44; Neder et al&#46;<a class="elsevierStyleCrossRef" href="#bib0035"><span class="elsevierStyleSup">2</span></a> proposed predicted values of MIP and MEP&#44; which were later questioned by Parreira et al&#46;<a class="elsevierStyleCrossRef" href="#bib0040"><span class="elsevierStyleSup">3</span></a> These authors reported different results in subsequent studies&#44; suggesting that the use of the predictive values published by Neder et al&#46;<a class="elsevierStyleCrossRef" href="#bib0035"><span class="elsevierStyleSup">2</span></a> were not applicable to the target population&#46; More recently&#44; Costa et al&#46;<a class="elsevierStyleCrossRef" href="#bib0045"><span class="elsevierStyleSup">4</span></a> recommended new equations for the determination of MIP and MEP&#44; and proposed that their findings could contribute to the study by Neder et al&#46;<a class="elsevierStyleCrossRef" href="#bib0035"><span class="elsevierStyleSup">2</span></a> by predicting&#44; in particular&#44; inspiratory muscle strength&#46;</p><p id="par0010" class="elsevierStylePara elsevierViewall">The previous studies<a class="elsevierStyleCrossRefs" href="#bib0030"><span class="elsevierStyleSup">1&#8211;4</span></a> that formulated the predicted values for the Brazilian population used an aneroid manometer to measure respiratory muscle strength&#46; Only one single Brazilian study<a class="elsevierStyleCrossRef" href="#bib0050"><span class="elsevierStyleSup">5</span></a> recently reported the reference values using a digital manometer&#46; It is worth mentioning that currently the digital manometer is widely used in the clinical practice of respiratory therapy&#44; and most importantly&#44; the predicted values formulated with the equations developed with the aneroid manometer do not always match the results obtained with a digital manometer&#46; In addition&#44; the interpretation of the pulmonary function of a given individual is based on data comparisons obtained with healthy subjects&#44; and do not take into account the effects of specific disfunctions the patients may have&#46; As there are no specific equations for people with certain diseases&#44; the results may not always correspond to those observed in clinical practice&#46;</p><p id="par0015" class="elsevierStylePara elsevierViewall">Given the lack of reference equations for patients with type 2 diabetes mellitus &#40;DM2&#41;&#44; in addition to the fact that there has only been one single publication conducted with a digital manometer&#44; the objective of this study was to compare&#44; in a population of patients with DM2&#44; the MIP and MEP values obtained with a digital manometer against the values predicted by the equations proposed for the healthy Brazilian population&#44; which were based on evaluations conducted with an aneroid manometer&#46; Additionally&#44; this study proposes new equations to determine the predicted values of MIP and MEP for patients with DM2 based on evaluations of the respiratory muscle strength conducted with a digital manometer&#46; The hypothesis of this study was that the values obtained in patients with DM2 with a digital manometer differ from the values provided for the healthy population which were based on evaluations conduced with an aneroid manometer&#44; and that new equations should therefore be formulated&#46;</p><p id="par0020" class="elsevierStylePara elsevierViewall">The values of MIP and MEP were measured in 219 patients with DM2&#44; aged under 75&#44; living in the urban area of Iju&#237;&#47;Brazil&#44; with calibrated digital manometer MVD-300 &#40;Microhard System&#44; Globalmed&#44; Porto Alegre&#44; Brazil&#41;&#46; All participants underwent at least six&#44; technically acceptable&#44; efforts of maximum inspiration and expiration&#46; For data analysis&#44; the highest value was recorded&#44; as long as there is not more than 10 percent of difference compared to the second highest value&#46;</p><p id="par0025" class="elsevierStylePara elsevierViewall">Among the patients studied&#44; 64&#46;8 percent were female&#44; average age of 61&#46;4<span class="elsevierStyleHsp" style=""></span>&#177;<span class="elsevierStyleHsp" style=""></span>9&#46;5 years old and body mass index of 30&#46;9<span class="elsevierStyleHsp" style=""></span>&#177;<span class="elsevierStyleHsp" style=""></span>5&#46;9<span class="elsevierStyleHsp" style=""></span>kg&#47;m<span class="elsevierStyleSup">2</span>&#46; The average time of DM2 diagnosis was 7&#46;4<span class="elsevierStyleHsp" style=""></span>&#177;<span class="elsevierStyleHsp" style=""></span>6&#46;7 years&#44; ranging from 0&#46;5 to 40 years and the average fasting blood glucose was 126&#46;4<span class="elsevierStyleHsp" style=""></span>&#177;<span class="elsevierStyleHsp" style=""></span>53&#46;1<span class="elsevierStyleHsp" style=""></span>mg&#47;dL&#44; with minimum value of 55&#46;0<span class="elsevierStyleHsp" style=""></span>mg&#47;dL and maximum of 219&#46;0<span class="elsevierStyleHsp" style=""></span>mg&#47;dL&#46; The average of maximal respiratory pressures achieved and predicted in male and female are recorded in <a class="elsevierStyleCrossRef" href="#tbl0005">Table 1</a>&#46;</p><elsevierMultimedia ident="tbl0005"></elsevierMultimedia><p id="par0030" class="elsevierStylePara elsevierViewall">When comparing the difference between the predicted and achieved values of MIP and MEP&#44; there was a statistically significant difference between them&#44; in both sexes&#46; In post hoc Bonferroni analysis&#44; in men&#44; the value predicted by Costa et al&#46;<a class="elsevierStyleCrossRef" href="#bib0045"><span class="elsevierStyleSup">4</span></a> is higher than PImax achieved by patients &#40;<span class="elsevierStyleItalic">p</span><span class="elsevierStyleHsp" style=""></span>&#60;<span class="elsevierStyleHsp" style=""></span>0&#46;0001&#41; and it is higher than equation values predicted by Neder et al&#46;<a class="elsevierStyleCrossRef" href="#bib0035"><span class="elsevierStyleSup">2</span></a> &#40;<span class="elsevierStyleItalic">p</span><span class="elsevierStyleHsp" style=""></span>&#60;<span class="elsevierStyleHsp" style=""></span>0&#46;0001&#41;&#46; The Neder et al&#46;<a class="elsevierStyleCrossRef" href="#bib0035"><span class="elsevierStyleSup">2</span></a> values were similar to those achieved by the patients &#40;<span class="elsevierStyleItalic">p</span><span class="elsevierStyleHsp" style=""></span>&#62;<span class="elsevierStyleHsp" style=""></span>0&#46;05&#41;&#46; In women it was found that the value predicted by Costa et al&#46;<a class="elsevierStyleCrossRef" href="#bib0045"><span class="elsevierStyleSup">4</span></a> equation was statistically lower than that achieved by patients &#40;<span class="elsevierStyleItalic">p</span><span class="elsevierStyleHsp" style=""></span>&#60;<span class="elsevierStyleHsp" style=""></span>0&#46;0001&#41;&#46; The values predicted by Neder et al&#46;<a class="elsevierStyleCrossRef" href="#bib0035"><span class="elsevierStyleSup">2</span></a> equation are closer to the value found in the test&#44; but they are significantly different when compared to the scores obtained by the patients &#40;<span class="elsevierStyleItalic">p</span><span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>0&#46;021&#41; &#40;<a class="elsevierStyleCrossRef" href="#tbl0005">Table 1</a>&#41;&#46;</p><p id="par0035" class="elsevierStylePara elsevierViewall">Regarding the MEP&#44; the values proposed by Costa et al&#46;<a class="elsevierStyleCrossRef" href="#bib0045"><span class="elsevierStyleSup">4</span></a> equation showed equivalent numbers to those achieved by patients&#44; with no significant difference between the sexes &#40;<span class="elsevierStyleItalic">p</span><span class="elsevierStyleHsp" style=""></span>&#62;<span class="elsevierStyleHsp" style=""></span>0&#46;05&#41;&#46; On the other hand&#44; the Neder et al&#46;<a class="elsevierStyleCrossRef" href="#bib0035"><span class="elsevierStyleSup">2</span></a> equation shows a considerably higher predicted value than the value achieved by patients&#44; for both sexes &#40;<span class="elsevierStyleItalic">p</span><span class="elsevierStyleHsp" style=""></span>&#60;<span class="elsevierStyleHsp" style=""></span>0&#46;0001&#41;&#46; There was a significant difference between the values predicted by both Costa et al&#46;<a class="elsevierStyleCrossRef" href="#bib0045"><span class="elsevierStyleSup">4</span></a> and Neder et al&#46;<a class="elsevierStyleCrossRef" href="#bib0035"><span class="elsevierStyleSup">2</span></a> equations &#40;<span class="elsevierStyleItalic">p</span><span class="elsevierStyleHsp" style=""></span>&#60;<span class="elsevierStyleHsp" style=""></span>0&#46;001&#41; &#40;<a class="elsevierStyleCrossRef" href="#tbl0005">Table 1</a>&#41;&#46;</p><p id="par0040" class="elsevierStylePara elsevierViewall">The Pearson correlation coefficient was used to determine which variables best explained the maximal respiratory pressures values&#46; For men&#44; negative correlations were observed between MIP and age &#40;<span class="elsevierStyleItalic">r</span><span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>&#8722;0&#46;374&#59; <span class="elsevierStyleItalic">p</span><span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>0&#46;001&#41; and between MEP and age &#40;<span class="elsevierStyleItalic">r</span><span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>&#8722;0&#46;379&#59; <span class="elsevierStyleItalic">p</span><span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>0&#46;001&#41; and positive correlations between MEP and body mass &#40;<span class="elsevierStyleItalic">r</span><span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>0&#46;340&#59; <span class="elsevierStyleItalic">p</span><span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>0&#46;003&#41;&#46; For women&#44; there was a negative correlation between MIP and age &#40;<span class="elsevierStyleItalic">r</span><span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>&#8722;0&#46;216&#59; <span class="elsevierStyleItalic">p</span><span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>0&#46;021&#41; and MEP and age &#40;<span class="elsevierStyleItalic">r</span><span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>&#8722;0&#46;192&#59; <span class="elsevierStyleItalic">p</span><span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>0&#46;027&#41;&#46;</p><p id="par0045" class="elsevierStylePara elsevierViewall">Based on the linear regression model&#44; gender&#44; age and body mass were considered predictor variables to determine the MEP for men&#46; <a class="elsevierStyleCrossRef" href="#tbl0010">Table 2</a> describes the equations for MIP and MEP which have been proposed for patients with DM2 from the digital manometer&#46; The equations obtained the following coefficients of determination &#40;<span class="elsevierStyleItalic">R</span><span class="elsevierStyleSup">2</span>&#41; and standard error of the estimate &#40;SEE&#41; for men&#58; MIP &#40;<span class="elsevierStyleItalic">R</span><span class="elsevierStyleSup">2</span><span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>14&#46;0&#44; SEE<span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>39&#46;1&#41;&#59; MEP &#40;<span class="elsevierStyleItalic">R</span><span class="elsevierStyleSup">2</span><span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>21&#46;9&#44; SEE<span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>27&#46;7&#41; and for women&#58; MIP &#40;<span class="elsevierStyleItalic">R</span><span class="elsevierStyleSup">2</span><span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>4&#46;7&#59; EPE<span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>27&#46;1&#41; MEP &#40;<span class="elsevierStyleItalic">R</span><span class="elsevierStyleSup">2</span><span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>3&#46;7&#59; EPE<span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>27&#46;5&#41;&#46; There is no collinearity between predictor variables MEP in men &#40;tolerance&#58;0&#46;966&#59; inflation factor of variance&#58;1&#46;035&#41;&#46;</p><elsevierMultimedia ident="tbl0010"></elsevierMultimedia><p id="par0050" class="elsevierStylePara elsevierViewall">To the best of our knowledge&#44; it is the first study to propose equations to obtain reference values for patients with DM2 of the population&#44; and the second one to establish reference values for the maximal respiratory pressures from digital manometer measuring&#46; Thus&#44; the results of this study may contribute to the prediction of maximal respiratory pressures in patients with DM2&#44; in particular&#44; measurements by digital manometer&#46; It is important to point out that further studies with patients from different regions of Brazil and with different characteristics are still needed&#44; so that they can formulate new tables or equations for determining the maximal respiratory pressures in patients with DM2&#46;</p><span id="sec0025" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0025">Authorship</span><p id="par0070" class="elsevierStylePara elsevierViewall">Fontela PC participated in the conception&#44; design&#44; analysis and interpretation of data and article&#46;</p><p id="par0075" class="elsevierStylePara elsevierViewall">Kuhn LA participated in the analysis and interpretation of data and article&#46;</p><p id="par0080" class="elsevierStylePara elsevierViewall">Winkelmann ER participated in all stages of the study&#46;</p></span><span id="sec0030" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0030">Conflict of interest</span><p id="par0085" class="elsevierStylePara elsevierViewall">We declare no conflicts of scientific interest in this study&#46;</p></span></span>"
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                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">&#8722;79&#46;3<span class="elsevierStyleHsp" style=""></span>&#177;<span class="elsevierStyleHsp" style=""></span>15&#46;5&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">91&#46;4&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">155&#46;9&nbsp;\t\t\t\t\t\t\n
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                    0 => array:2 [
                      "titulo" => "Press&#245;es respirat&#243;rias m&#225;ximas em adultos normais"
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                          "etal" => false
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                      "autores" => array:1 [
                        0 => array:2 [
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                            0 => "J&#46;A&#46; Neder"
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                      "titulo" => "Novos valores de refer&#234;ncia para press&#245;es respirat&#243;rias m&#225;ximas na popula&#231;&#227;o brasileira"
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Research Letter
Reference values for maximum respiratory pressures in patients with type 2 diabetes mellitus
P. Caitano Fontelaa, L.A. Kuhnb, E.R. Winkelmannc,
Corresponding author
elianew@unijui.edu.br

Corresponding author.
a Postgraduate Program Ciências Pneumológicas, Universidade Federal do Rio Grande do Sul – UFRGS, Porto Alegre, RS, Brazil
b Department of Ciências da Vida, Universidade Regional do Noroeste do Estado do Rio Grande do Sul – UNIJUÍ, Ijuí, RS, Brazil
c Master's Degree Program Atenção Integral à Saúde, Department of Ciências da Vida, Universidade Regional do Noroeste do Estado do Rio Grande do Sul – UNIJUÍ, Ijuí, RS, Brazil
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    "textoCompleto" => "<span class="elsevierStyleSections"><p id="par0005" class="elsevierStylePara elsevierViewall">In Brazil there are few published studies on the reference values of maximal respiratory pressures&#46; The first publication was written by Camelo Jr et al&#46;&#44;<a class="elsevierStyleCrossRef" href="#bib0030"><span class="elsevierStyleSup">1</span></a> who&#44; in 1985&#44; was a pioneer in the field by suggesting maximal inspiratory &#40;MIP&#41; and expiratory &#40;MEP&#41; pressure values for the Brazilian adult population&#46; A few years later&#44; Neder et al&#46;<a class="elsevierStyleCrossRef" href="#bib0035"><span class="elsevierStyleSup">2</span></a> proposed predicted values of MIP and MEP&#44; which were later questioned by Parreira et al&#46;<a class="elsevierStyleCrossRef" href="#bib0040"><span class="elsevierStyleSup">3</span></a> These authors reported different results in subsequent studies&#44; suggesting that the use of the predictive values published by Neder et al&#46;<a class="elsevierStyleCrossRef" href="#bib0035"><span class="elsevierStyleSup">2</span></a> were not applicable to the target population&#46; More recently&#44; Costa et al&#46;<a class="elsevierStyleCrossRef" href="#bib0045"><span class="elsevierStyleSup">4</span></a> recommended new equations for the determination of MIP and MEP&#44; and proposed that their findings could contribute to the study by Neder et al&#46;<a class="elsevierStyleCrossRef" href="#bib0035"><span class="elsevierStyleSup">2</span></a> by predicting&#44; in particular&#44; inspiratory muscle strength&#46;</p><p id="par0010" class="elsevierStylePara elsevierViewall">The previous studies<a class="elsevierStyleCrossRefs" href="#bib0030"><span class="elsevierStyleSup">1&#8211;4</span></a> that formulated the predicted values for the Brazilian population used an aneroid manometer to measure respiratory muscle strength&#46; Only one single Brazilian study<a class="elsevierStyleCrossRef" href="#bib0050"><span class="elsevierStyleSup">5</span></a> recently reported the reference values using a digital manometer&#46; It is worth mentioning that currently the digital manometer is widely used in the clinical practice of respiratory therapy&#44; and most importantly&#44; the predicted values formulated with the equations developed with the aneroid manometer do not always match the results obtained with a digital manometer&#46; In addition&#44; the interpretation of the pulmonary function of a given individual is based on data comparisons obtained with healthy subjects&#44; and do not take into account the effects of specific disfunctions the patients may have&#46; As there are no specific equations for people with certain diseases&#44; the results may not always correspond to those observed in clinical practice&#46;</p><p id="par0015" class="elsevierStylePara elsevierViewall">Given the lack of reference equations for patients with type 2 diabetes mellitus &#40;DM2&#41;&#44; in addition to the fact that there has only been one single publication conducted with a digital manometer&#44; the objective of this study was to compare&#44; in a population of patients with DM2&#44; the MIP and MEP values obtained with a digital manometer against the values predicted by the equations proposed for the healthy Brazilian population&#44; which were based on evaluations conducted with an aneroid manometer&#46; Additionally&#44; this study proposes new equations to determine the predicted values of MIP and MEP for patients with DM2 based on evaluations of the respiratory muscle strength conducted with a digital manometer&#46; The hypothesis of this study was that the values obtained in patients with DM2 with a digital manometer differ from the values provided for the healthy population which were based on evaluations conduced with an aneroid manometer&#44; and that new equations should therefore be formulated&#46;</p><p id="par0020" class="elsevierStylePara elsevierViewall">The values of MIP and MEP were measured in 219 patients with DM2&#44; aged under 75&#44; living in the urban area of Iju&#237;&#47;Brazil&#44; with calibrated digital manometer MVD-300 &#40;Microhard System&#44; Globalmed&#44; Porto Alegre&#44; Brazil&#41;&#46; All participants underwent at least six&#44; technically acceptable&#44; efforts of maximum inspiration and expiration&#46; For data analysis&#44; the highest value was recorded&#44; as long as there is not more than 10 percent of difference compared to the second highest value&#46;</p><p id="par0025" class="elsevierStylePara elsevierViewall">Among the patients studied&#44; 64&#46;8 percent were female&#44; average age of 61&#46;4<span class="elsevierStyleHsp" style=""></span>&#177;<span class="elsevierStyleHsp" style=""></span>9&#46;5 years old and body mass index of 30&#46;9<span class="elsevierStyleHsp" style=""></span>&#177;<span class="elsevierStyleHsp" style=""></span>5&#46;9<span class="elsevierStyleHsp" style=""></span>kg&#47;m<span class="elsevierStyleSup">2</span>&#46; The average time of DM2 diagnosis was 7&#46;4<span class="elsevierStyleHsp" style=""></span>&#177;<span class="elsevierStyleHsp" style=""></span>6&#46;7 years&#44; ranging from 0&#46;5 to 40 years and the average fasting blood glucose was 126&#46;4<span class="elsevierStyleHsp" style=""></span>&#177;<span class="elsevierStyleHsp" style=""></span>53&#46;1<span class="elsevierStyleHsp" style=""></span>mg&#47;dL&#44; with minimum value of 55&#46;0<span class="elsevierStyleHsp" style=""></span>mg&#47;dL and maximum of 219&#46;0<span class="elsevierStyleHsp" style=""></span>mg&#47;dL&#46; The average of maximal respiratory pressures achieved and predicted in male and female are recorded in <a class="elsevierStyleCrossRef" href="#tbl0005">Table 1</a>&#46;</p><elsevierMultimedia ident="tbl0005"></elsevierMultimedia><p id="par0030" class="elsevierStylePara elsevierViewall">When comparing the difference between the predicted and achieved values of MIP and MEP&#44; there was a statistically significant difference between them&#44; in both sexes&#46; In post hoc Bonferroni analysis&#44; in men&#44; the value predicted by Costa et al&#46;<a class="elsevierStyleCrossRef" href="#bib0045"><span class="elsevierStyleSup">4</span></a> is higher than PImax achieved by patients &#40;<span class="elsevierStyleItalic">p</span><span class="elsevierStyleHsp" style=""></span>&#60;<span class="elsevierStyleHsp" style=""></span>0&#46;0001&#41; and it is higher than equation values predicted by Neder et al&#46;<a class="elsevierStyleCrossRef" href="#bib0035"><span class="elsevierStyleSup">2</span></a> &#40;<span class="elsevierStyleItalic">p</span><span class="elsevierStyleHsp" style=""></span>&#60;<span class="elsevierStyleHsp" style=""></span>0&#46;0001&#41;&#46; The Neder et al&#46;<a class="elsevierStyleCrossRef" href="#bib0035"><span class="elsevierStyleSup">2</span></a> values were similar to those achieved by the patients &#40;<span class="elsevierStyleItalic">p</span><span class="elsevierStyleHsp" style=""></span>&#62;<span class="elsevierStyleHsp" style=""></span>0&#46;05&#41;&#46; In women it was found that the value predicted by Costa et al&#46;<a class="elsevierStyleCrossRef" href="#bib0045"><span class="elsevierStyleSup">4</span></a> equation was statistically lower than that achieved by patients &#40;<span class="elsevierStyleItalic">p</span><span class="elsevierStyleHsp" style=""></span>&#60;<span class="elsevierStyleHsp" style=""></span>0&#46;0001&#41;&#46; The values predicted by Neder et al&#46;<a class="elsevierStyleCrossRef" href="#bib0035"><span class="elsevierStyleSup">2</span></a> equation are closer to the value found in the test&#44; but they are significantly different when compared to the scores obtained by the patients &#40;<span class="elsevierStyleItalic">p</span><span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>0&#46;021&#41; &#40;<a class="elsevierStyleCrossRef" href="#tbl0005">Table 1</a>&#41;&#46;</p><p id="par0035" class="elsevierStylePara elsevierViewall">Regarding the MEP&#44; the values proposed by Costa et al&#46;<a class="elsevierStyleCrossRef" href="#bib0045"><span class="elsevierStyleSup">4</span></a> equation showed equivalent numbers to those achieved by patients&#44; with no significant difference between the sexes &#40;<span class="elsevierStyleItalic">p</span><span class="elsevierStyleHsp" style=""></span>&#62;<span class="elsevierStyleHsp" style=""></span>0&#46;05&#41;&#46; On the other hand&#44; the Neder et al&#46;<a class="elsevierStyleCrossRef" href="#bib0035"><span class="elsevierStyleSup">2</span></a> equation shows a considerably higher predicted value than the value achieved by patients&#44; for both sexes &#40;<span class="elsevierStyleItalic">p</span><span class="elsevierStyleHsp" style=""></span>&#60;<span class="elsevierStyleHsp" style=""></span>0&#46;0001&#41;&#46; There was a significant difference between the values predicted by both Costa et al&#46;<a class="elsevierStyleCrossRef" href="#bib0045"><span class="elsevierStyleSup">4</span></a> and Neder et al&#46;<a class="elsevierStyleCrossRef" href="#bib0035"><span class="elsevierStyleSup">2</span></a> equations &#40;<span class="elsevierStyleItalic">p</span><span class="elsevierStyleHsp" style=""></span>&#60;<span class="elsevierStyleHsp" style=""></span>0&#46;001&#41; &#40;<a class="elsevierStyleCrossRef" href="#tbl0005">Table 1</a>&#41;&#46;</p><p id="par0040" class="elsevierStylePara elsevierViewall">The Pearson correlation coefficient was used to determine which variables best explained the maximal respiratory pressures values&#46; For men&#44; negative correlations were observed between MIP and age &#40;<span class="elsevierStyleItalic">r</span><span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>&#8722;0&#46;374&#59; <span class="elsevierStyleItalic">p</span><span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>0&#46;001&#41; and between MEP and age &#40;<span class="elsevierStyleItalic">r</span><span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>&#8722;0&#46;379&#59; <span class="elsevierStyleItalic">p</span><span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>0&#46;001&#41; and positive correlations between MEP and body mass &#40;<span class="elsevierStyleItalic">r</span><span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>0&#46;340&#59; <span class="elsevierStyleItalic">p</span><span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>0&#46;003&#41;&#46; For women&#44; there was a negative correlation between MIP and age &#40;<span class="elsevierStyleItalic">r</span><span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>&#8722;0&#46;216&#59; <span class="elsevierStyleItalic">p</span><span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>0&#46;021&#41; and MEP and age &#40;<span class="elsevierStyleItalic">r</span><span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>&#8722;0&#46;192&#59; <span class="elsevierStyleItalic">p</span><span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>0&#46;027&#41;&#46;</p><p id="par0045" class="elsevierStylePara elsevierViewall">Based on the linear regression model&#44; gender&#44; age and body mass were considered predictor variables to determine the MEP for men&#46; <a class="elsevierStyleCrossRef" href="#tbl0010">Table 2</a> describes the equations for MIP and MEP which have been proposed for patients with DM2 from the digital manometer&#46; The equations obtained the following coefficients of determination &#40;<span class="elsevierStyleItalic">R</span><span class="elsevierStyleSup">2</span>&#41; and standard error of the estimate &#40;SEE&#41; for men&#58; MIP &#40;<span class="elsevierStyleItalic">R</span><span class="elsevierStyleSup">2</span><span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>14&#46;0&#44; SEE<span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>39&#46;1&#41;&#59; MEP &#40;<span class="elsevierStyleItalic">R</span><span class="elsevierStyleSup">2</span><span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>21&#46;9&#44; SEE<span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>27&#46;7&#41; and for women&#58; MIP &#40;<span class="elsevierStyleItalic">R</span><span class="elsevierStyleSup">2</span><span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>4&#46;7&#59; EPE<span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>27&#46;1&#41; MEP &#40;<span class="elsevierStyleItalic">R</span><span class="elsevierStyleSup">2</span><span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>3&#46;7&#59; EPE<span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>27&#46;5&#41;&#46; There is no collinearity between predictor variables MEP in men &#40;tolerance&#58;0&#46;966&#59; inflation factor of variance&#58;1&#46;035&#41;&#46;</p><elsevierMultimedia ident="tbl0010"></elsevierMultimedia><p id="par0050" class="elsevierStylePara elsevierViewall">To the best of our knowledge&#44; it is the first study to propose equations to obtain reference values for patients with DM2 of the population&#44; and the second one to establish reference values for the maximal respiratory pressures from digital manometer measuring&#46; Thus&#44; the results of this study may contribute to the prediction of maximal respiratory pressures in patients with DM2&#44; in particular&#44; measurements by digital manometer&#46; It is important to point out that further studies with patients from different regions of Brazil and with different characteristics are still needed&#44; so that they can formulate new tables or equations for determining the maximal respiratory pressures in patients with DM2&#46;</p><span id="sec0025" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0025">Authorship</span><p id="par0070" class="elsevierStylePara elsevierViewall">Fontela PC participated in the conception&#44; design&#44; analysis and interpretation of data and article&#46;</p><p id="par0075" class="elsevierStylePara elsevierViewall">Kuhn LA participated in the analysis and interpretation of data and article&#46;</p><p id="par0080" class="elsevierStylePara elsevierViewall">Winkelmann ER participated in all stages of the study&#46;</p></span><span id="sec0030" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0030">Conflict of interest</span><p id="par0085" class="elsevierStylePara elsevierViewall">We declare no conflicts of scientific interest in this study&#46;</p></span></span>"
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          "leyenda" => "<p id="spar0010" class="elsevierStyleSimplePara elsevierViewall">cmH<span class="elsevierStyleInf">2</span>O&#58; centimeters of water&#59; &#37;&#58; percentage reached&#46;</p>"
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                  \t\t\t\t" class=""><thead title="thead"><tr title="table-row"><th class="td" title="table-head  " align="left" valign="top" scope="col" style="border-bottom: 2px solid black">Respiratory pressure&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</th><th class="td" title="table-head  " align="left" valign="top" scope="col" style="border-bottom: 2px solid black">Gender&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</th><th class="td" title="table-head  " align="left" valign="top" scope="col" style="border-bottom: 2px solid black">Measure&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</th><th class="td" title="table-head  " align="left" valign="top" scope="col" style="border-bottom: 2px solid black">Pressure predicted by Neder et al&#46;<a class="elsevierStyleCrossRef" href="#bib0035"><span class="elsevierStyleSup">2</span></a>&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</th><th class="td" title="table-head  " align="left" valign="top" scope="col" style="border-bottom: 2px solid black">Pressure predicted by Costa et al&#46;<a class="elsevierStyleCrossRef" href="#bib0045"><span class="elsevierStyleSup">4</span></a>&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</th><th class="td" title="table-head  " align="left" valign="top" scope="col" style="border-bottom: 2px solid black">Maximum pressure achieved&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t</th></tr></thead><tbody title="tbody"><tr title="table-row"><td class="td" title="table-entry  " rowspan="4" align="left" valign="top">Inspiratory</td><td class="td" title="table-entry  " rowspan="2" align="left" valign="top">Male &#40;<span class="elsevierStyleItalic">n</span><span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>77&#41;</td><td class="td" title="table-entry  " align="left" valign="top">cmH<span class="elsevierStyleInf">2</span>O&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">&#8722;107&#46;9<span class="elsevierStyleHsp" style=""></span>&#177;<span class="elsevierStyleHsp" style=""></span>13&#46;1&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t</td><td class="td" title="table-entry  " rowspan="2" align="char" valign="top">&#8722;93&#46;1<span class="elsevierStyleHsp" style=""></span>&#177;<span class="elsevierStyleHsp" style=""></span>41&#46;8</td><td class="td" title="table-entry  " rowspan="2" align="char" valign="top">&#60;0&#46;0001<a class="elsevierStyleCrossRef" href="#tblfn0005"><span class="elsevierStyleSup">a</span></a></td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top">&#37;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">86&#46;3&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">60&#46;5&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="table-entry  " rowspan="2" align="left" valign="top">Female &#40;<span class="elsevierStyleItalic">n</span><span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>142&#41;</td><td class="td" title="table-entry  " align="left" valign="top">cmH<span class="elsevierStyleInf">2</span>O&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">&#8722;79&#46;3<span class="elsevierStyleHsp" style=""></span>&#177;<span class="elsevierStyleHsp" style=""></span>15&#46;5&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">&#8722;46&#46;5<span class="elsevierStyleHsp" style=""></span>&#177;<span class="elsevierStyleHsp" style=""></span>4&#46;4&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " rowspan="2" align="char" valign="top">&#8722;72&#46;5<span class="elsevierStyleHsp" style=""></span>&#177;<span class="elsevierStyleHsp" style=""></span>27&#46;7</td><td class="td" title="table-entry  " rowspan="2" align="char" valign="top">&#60;0&#46;0001<a class="elsevierStyleCrossRef" href="#tblfn0005"><span class="elsevierStyleSup">a</span></a></td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top">&#37;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">91&#46;4&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">155&#46;9&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="table-entry  " rowspan="4" align="left" valign="top">Expiratory</td><td class="td" title="table-entry  " rowspan="2" align="left" valign="top">Male &#40;<span class="elsevierStyleItalic">n</span><span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>77&#41;</td><td class="td" title="table-entry  " align="left" valign="top">cmH<span class="elsevierStyleInf">2</span>O&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">173&#46;7<span class="elsevierStyleHsp" style=""></span>&#177;<span class="elsevierStyleHsp" style=""></span>41&#46;2&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">103&#46;5<span class="elsevierStyleHsp" style=""></span>&#177;<span class="elsevierStyleHsp" style=""></span>11&#46;2&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " rowspan="2" align="char" valign="top">101&#46;2<span class="elsevierStyleHsp" style=""></span>&#177;<span class="elsevierStyleHsp" style=""></span>30&#46;9</td><td class="td" title="table-entry  " rowspan="2" align="char" valign="top">&#60;0&#46;0001<a class="elsevierStyleCrossRef" href="#tblfn0005"><span class="elsevierStyleSup">a</span></a></td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top">&#37;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">58&#46;3&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">97&#46;8&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="table-entry  " rowspan="2" align="left" valign="top">Female &#40;<span class="elsevierStyleItalic">n</span><span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>142&#41;</td><td class="td" title="table-entry  " align="left" valign="top">cmH<span class="elsevierStyleInf">2</span>O&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t</td><td class="td" title="table-entry  " rowspan="2" align="char" valign="top">76&#46;9<span class="elsevierStyleHsp" style=""></span>&#177;<span class="elsevierStyleHsp" style=""></span>27&#46;9</td><td class="td" title="table-entry  " rowspan="2" align="char" valign="top">&#60;0&#46;0001<a class="elsevierStyleCrossRef" href="#tblfn0005"><span class="elsevierStyleSup">a</span></a></td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top">&#37;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">65&#46;8&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">98&#46;2&nbsp;\t\t\t\t\t\t\n
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          "en" => "<p id="spar0005" class="elsevierStyleSimplePara elsevierViewall">Absolute value and percentage reached the inspiratory and the expiratory maximal pressures achieved and predicted according to the equations of Neder et al&#46;<a class="elsevierStyleCrossRef" href="#bib0035"><span class="elsevierStyleSup">2</span></a> and Costa et al&#46;<a class="elsevierStyleCrossRef" href="#bib0045"><span class="elsevierStyleSup">4</span></a></p>"
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                  \t\t\t\t" class=""><thead title="thead"><tr title="table-row"><th class="td" title="table-head  " align="left" valign="top" scope="col" style="border-bottom: 2px solid black">Equations formulated for&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</th><th class="td" title="table-head  " align="left" valign="top" scope="col" style="border-bottom: 2px solid black">Men&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</th><th class="td" title="table-head  " align="left" valign="top" scope="col" style="border-bottom: 2px solid black">Women&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</th></tr></thead><tbody title="tbody"><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top">Maximal inspiratory pressures&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">204&#46;959<span class="elsevierStyleHsp" style=""></span>&#8722;<span class="elsevierStyleHsp" style=""></span>1&#46;772 &#40;age&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">110&#46;660<span class="elsevierStyleHsp" style=""></span>&#8722;<span class="elsevierStyleHsp" style=""></span>0&#46;633 &#40;age&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top">Maximal expiratory pressures&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">118&#46;972<span class="elsevierStyleHsp" style=""></span>&#8722;<span class="elsevierStyleHsp" style=""></span>1&#46;148 &#40;age&#41;<span class="elsevierStyleHsp" style=""></span>&#43;<span class="elsevierStyleHsp" style=""></span>0&#46;657 &#40;body mass&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">111&#46;236<span class="elsevierStyleHsp" style=""></span>&#8722;<span class="elsevierStyleHsp" style=""></span>0&#46;570 &#40;age&#41;&nbsp;\t\t\t\t\t\t\n
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                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "Press&#245;es respirat&#243;rias m&#225;ximas em adultos normais"
                      "autores" => array:1 [
                        0 => array:2 [
                          "etal" => false
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                            0 => "J&#46;S&#46; Camelo J&#250;nior"
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                      "Revista" => array:5 [
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                0 => array:2 [
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                      "titulo" => "Reference values for lung function tests&#46; II&#46; Maximal respiratory pressures and voluntary ventilation"
                      "autores" => array:1 [
                        0 => array:2 [
                          "etal" => false
                          "autores" => array:4 [
                            0 => "J&#46;A&#46; Neder"
                            1 => "S&#46; Andreoni"
                            2 => "M&#46;C&#46; Lerario"
                            3 => "L&#46;E&#46; Nery"
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                      "Revista" => array:6 [
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                            1 => "D&#46;C&#46; Fran&#231;a"
                            2 => "C&#46;C&#46; Zampa"
                            3 => "M&#46;M&#46; Fonseca"
                            4 => "G&#46;M&#46; Tomich"
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                        "tituloSerie" => "Rev Bras Fisioter"
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                        0 => array:2 [
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                            2 => "L&#46;P&#46; De Lima"
                            3 => "D&#46; Ike"
                            4 => "K&#46;M&#46; Cancelliero"
                            5 => "M&#46;I&#46;L&#46; Montebelo"
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                        "tituloSerie" => "J Bras Pneumol"
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Article information
ISSN: 21735115
Original language: English
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