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Multidisciplinary summary of the 4th National Sleep Conference

Between the 11th and 13th of June, the 4th Conference of Somnology and Non-Invasive Ventilation (NIV) Section of the Romanian Pulmonology Society was held in the city of Braşov. Preceded by a rehabilitation course organized by Senior Lecturer Prof. Postolache Paraschiva, the conference was a real success, judging by the growing numbers of attendees registered at each meeting and the feedback of those who attended the event. There were more than 400 participants were registered, such as pulmonologists, physicians with different specializations (neurologists, general medicine physicians, ENT physicians, paediatricians, cardiologists, occupational medicine physicians, family medicine physicians, psychiatrists, psychologists, emergency medicine physicians, anaesthesiologists, geriatric physicians, surgeons, physical medicine and rehabilitation physicians, dentists, dermatologists) and resident physicians from across the country, and also from Bulgaria and the Republic of Moldova; simultaneously, more than 120 nurses and medical technicians attended the special nurse section of the conference. The program was carried by 15 European and internationally renowned foreign lecturers from Belgium, Croatia, Denmark, Switzerland, France, Germany, Italy, Netherlands, Poland, Republic of Moldova, Spain, United States of America and 40 Romanian lecturers, during 61 scientific sessions and six symposiums held by our partners in the pharmaceutical industry. Along with the conference, two specialization courses were held: Hands-on Polygraph reading and Hands-on Polysomnography, a symposium dedicated to young sleep specialists and a poster session (23 posters exposed). At the end of the conference, the traditional somnology specialization exam took place.
The point of strength of this conference was demonstrated by the multidisciplinary characteristic of the event. For the first time, despite the fact that the pulmonologists prevailed, colleagues from different specializations were also present, it was the first time some fields of expertise attended and event of this nature. (See Figure 1).
Furthermore, an introductory meeting was held through which the participants learned about the achievements and limitations of Romanian somnology in the past years, from the president of the section, Dr. Oana Deleanu. The programme covered all areas of interest regarding sleep pathology, and was conducted simultaneously in two lyceums for three days. Thus, the programme approached topics such as Idiopathic Hypersomnia (Cristian Falup Pecurariu), Residual Sleepiness in patients with correctly treated obstructive sleep apnea (Francisco Havier Puertas Cuestas), sleep-dementia relationship (Cristina Panea), epilepsy and sleep (Ioana Mândruţă), biomarkers of sleep apnea (Oana Arghir), arrhythmias in patients suffering from severe OSA (Monica Pop) etc.
On the second day, other topics were discussed such as: Siesta - pathology or habit (Fl.Mihălţan), overweight-related issues - defence mechanism or cardiovascular risk marker (Dan Gaiţă), the effect of CPAP on blood pressure values (Oana Deleanu), physiopathology, clinical aspect and treatment of Cheyne-Stokes respiration (Martin Konnerman), the impact of therapeutic education on the use of CPAP as a treatment for OSA (Faysal el Husseini), fatigue syndrome (Ruxandra Ulmeanu), complex motor behaviour in relation with sleep (Claudio Bassetti), SAS scores for apnea syndrome ( Ştefan Dan Mihăicuţă), etc. A session for ENT physicians with highly engaging topics was conducted by famous physicians such as George Mincu, Adrian Neagos, Ioana Voda, and Dragos Stefanescu. A paedeatric session on the final day of the conference delved into topics such as: chronic snoring (Doina Pleşca), epidemiology of apnea syndrome (Mihalea Oros), the electrical status epilepticus during sleep in children (Raluca Teleanu) and insomnia (Oana Falup Pecurariu). Some of the other interesting topics discussed on Saturday, non-invasive ventilation, with sub-topics such as perioperative ventilation support (Radu Stoica), and artificial lungs (Dorel Sandesc and collab.).
The numerous topics addressed during the conference boasted two premiers: the contest of oral communication sustained by the young residents, in which awards were granted, and the attendance of a foreign guest during the session dedicated to nurses: Daniela Andrieş (Switzerland) who revealed very interesting aspects on the role of somnology technician.
There was also a follow-up of the conference where the feedback concerning the contemporary relevance of the topics discussed encouraged us to continue with similar initiatives. The contemporary relevance of the themes were considered «Good» by 45% and «Excellent» by the remaining 55%. n

A starting point in Non-Invasive Ventilation at Cluj-Napoca

In the middle of a little whimsical June weather, Cluj-Napoca hosted, between the 25th and the 27th of June 2015, a unique scientific event organized by the Respiratory Physiopathology Department of the Romanian Society of Pulmonology. It could be more accurately described as a workshop with the exciting title of "The Management of Respiratory Failure. From theory to practice in Non-Invasive Ventilation", a beautiful and interesting story, through which Doina Todea and Gabi Popescu highlighted, as a foreword, the importance of this topic, given the necessity of knowing how to perform non-invasive ventilation therapy (NIV) on patients who suffer from chronic respiratory failure. NIV is a new issue for pulmonologists, but is a familiar subject for intensive care unit physicians.
During the first day, the busy yet interesting schedule, that featured numerous debates, began with a series of presentations that approached introductory elements of NIV, carried out by Ivana Sundov (Croatia), in which she described the general benefits, disadvantages, exclusion criteria, at-home ventilation indications and ventilation parameters and techniques. The workshop continued with the presentation of the main benefits of NIV in the treatment of chronic respiratory failure - indications and limitations, presented by Doina Todea (Cluj-Napoca), and Ruxandra Rajnoveanu (Cluj-Napoca), who underlined what pulmonologists should know about NIV and chronic hypercapnic respiratory failure exacerbated by chronic obstructive pulmonary disease (COPD).
The second set of presentations brought pumonologists and intensive care unit physicians "face-to-face" with an extremely constructive debate of great scientific quality. The spotlight was shared by Natalia Hagau, who presented the organization pattern of CPAP services in hospitals, and Sebastian Tranca, who detailed the CPAP technique outside the ICU in the University of Cluj-Napoca. On the other side of the debate, Ovidiu Bedreag from Timisoara proposed a presentation which demonstrated the importance of Non-Invasive Ventilation procedure in daily medical practical practice.
An efficient Non-Invasive Ventilation procedure would be impossible without clear and permeable airways. In this regard, Mihaela Oros (Bucharest) delighted us with a unique presentation of the complete management of secretions in patients undergoing non-invasive ventilation.
COPD was also mentioned among the three topics broached by Ruxandra Ulmeanu (Bucharest) who spoke about the importance of controlling COPD as a completely new concept. Dorin Vancea (Timisoara) discussed non-inhalation therapies to prevent acute exacerbations of, and hospitalizations due to, COPD, as well as the role of exacerbations during COPD (Monica Pop, Cluj-Napoca). These presentations convinced us of the importance of the illness, which is one of the most common lung disease that requires numerous hospitalizations as it steadily evolves into respiratory failure.
After these presentations, the discussions transitioned a closely linked topic, somnology, and Oana Deleanu (Bucharest) confirmed once again the importance of clinical practice as a diagnostic and therapeutic solution for central sleep apnea syndrome and Cheyne-Stokes respiration. Furthermore, the ENT section brought a presentation of the pathology that raised many discussions regarding the positive, differential and therapeutic diagnosis of the vocal chord dysfunction (Rodica Muresan, Cluj-Napoca).
At the end of a day filled with numerous theoretical topics, after a short introduction of the correct method of fitting the patient's ventilation mask (Ivana Sundov), it was time for actual "practice exercises" with the apparatus and devices used for Non-Invasive Ventilation. It was a very interesting session, where many young residents were present, along with pulmonologists and other experienced physicians. The day was completed with an outstanding symposium about news in Non-Invasive Ventilation.
On the second day, during the first symposium, themes such as neuromuscular and cardiovascular disease were also approached, especially cerebrovascular accident, where amazing arguments were brought about the importance of NIV in these pathologies by Lavinia Davidescu (Oradea), who discussed the management of respiratory failure due to amyotrophic lateral sclerosis, and Zoltan Szakacs (Budapest), who presented the benefits of Non-Invasive Ventilation therapy in AVC and Neuromuscular Diseases. Another topic broached a familiar subject to us pulmonologists, and once again clarified the physiopathological mechanisms, the classification, and the positive and differential diagnosis of Chronic Respiratory Failure (Man Milena, Cluj-Napoca. Then we discussed the widely-known, yet very challenging, procedure for the treatment of patients with Respiratory Failure through „Oxygen Therapy and CRI - a long way from where we started to where we arrived" (Florin Mihaltan, Bucharest).The discussion continued with the actual meaning of the implication and importance of the ventilation support, according to patient's physiopathological mechanism of respiratory insufficiency, which was elegantly and scientifically explained by Stefan Dumitrache - Rujinski (Bucharest). The discussion also included the importance of respiratory muscle training using POWER Breath devices, presented by Dan Simule (Germany) and Paraschiva Postolache (Iasi). An enchanting and challenging point of the workshop was the presentation of clinical cases, carried out by young pulmonologists who shared unique cases from modern day.
We enjoyed two days of discussions with a large number of participants, over 100 physicians, in a field which is still new to pulmonologists: Non-Invasive Ventilation. In a friendly and pleasant environment, the attendees found the city of Cluj as welcoming as always during such scientific events, showing once again that through the effort of the organizers, this start in Non-Invasive Ventilation can, and will, continue and has a promising future in the modern medical practice of pulmonologists. n