HAUT HMV Brazil Grand Rounds April 29 2014

8/15/2019 HAUT HMV Brazil Grand Rounds April 29 2014

1/74

Sklaus Pfragjakgjaihsg

(SPK) Rrapfyidxhs

Kiihatt Z. Fdut, G@, CDEU Dssaehdtk Rrackssar ac Uurnkry & Dlkstfkshaiany / Erhthedi Edrk Gk`hehlk &

Kgkrnkley Gk`hehlk

Dprhi :8, :240 Nrdl` Zaul`s- Fasphtdi Gahlfas `k Sklta Rarta Diknrk, Jrdzhi


2/74

• @kkp Skhl Pfragjashs (@SP)

• Ruigaldry Kgjaihsg (RK)

^fdt hs Sklaus

Pfragjakgjaihsg (SPK) 1


3/74

^fdt Edusks Sklaus

Pfragjakgjaihsg (SPK)1

Fypkreadnudjhihty

Zu`aic Shrefaw (46:4-482:)


4/74

^fy caeus al SPK1

• SPK hs eaggal

― 5;2,222 ta 322,222 Dgkrhedls succkr @SPdl`/ar RK kdef ykdr

― Atfkrs rkpart < :

ghiihal edsks

fttp?//www.surnkalnklkrdi.nav/taphes/`kkpvkhl/ediitadethal/edii-ta-dethal-al-

`vt-:226.p`c

http://www.surgeongeneral.gov/topics/deepvein/calltoaction/call-to-action-on-dvt-2008.pdfhttp://www.surgeongeneral.gov/topics/deepvein/calltoaction/call-to-action-on-dvt-2008.pdfhttp://www.surgeongeneral.gov/topics/deepvein/calltoaction/call-to-action-on-dvt-2008.pdfhttp://www.surgeongeneral.gov/topics/deepvein/calltoaction/call-to-action-on-dvt-2008.pdfhttp://www.surgeongeneral.gov/topics/deepvein/calltoaction/call-to-action-on-dvt-2008.pdfhttp://www.surgeongeneral.gov/topics/deepvein/calltoaction/call-to-action-on-dvt-2008.pdfhttp://www.surgeongeneral.gov/topics/deepvein/calltoaction/call-to-action-on-dvt-2008.pdfhttp://www.surgeongeneral.gov/topics/deepvein/calltoaction/call-to-action-on-dvt-2008.pdfhttp://www.surgeongeneral.gov/topics/deepvein/calltoaction/call-to-action-on-dvt-2008.pdfhttp://www.surgeongeneral.gov/topics/deepvein/calltoaction/call-to-action-on-dvt-2008.pdfhttp://www.surgeongeneral.gov/topics/deepvein/calltoaction/call-to-action-on-dvt-2008.pdfhttp://www.surgeongeneral.gov/topics/deepvein/calltoaction/call-to-action-on-dvt-2008.pdfhttp://www.surgeongeneral.gov/topics/deepvein/calltoaction/call-to-action-on-dvt-2008.pdfhttp://www.surgeongeneral.gov/topics/deepvein/calltoaction/call-to-action-on-dvt-2008.pdfhttp://www.surgeongeneral.gov/topics/deepvein/calltoaction/call-to-action-on-dvt-2008.pdf


5/74

Oafls Fapmhls @SP Uygpashug

:228


6/74

• @kd`iy

― )

• DH@U (4;,;:8)

^fy caeus al SPK1


7/74

^fy caeus al SPK1

• Edusks ialn-tkrg garjh`hty ― Zkeurrklt SPK aeeurs hl 02% jy 42 ykdrs

― Rast-tfragjathe syl`ragk dcckets 52%• Hlerkdsks iklntf ac stdy dl` east

― $42,222-$43,222 pkr kvklt

― Dlludi `hrket easts ~ $:22 ghiihal dlludiiy ― Avkrdii east ta [U kealagy ~ $8-$42 jhiihal


8/74

Zhsm Cdetars car SPK

• Dnk

• Edlekr

• Efkgatfkrdpy• Rrkvhaus @SP/RK

• Prdugd

• Gdoar surnkry

• Fasphtdihzdthal

• Pfragjapfhihd

• Rrknldley

• Fargalk tfkrdpy

• Cdghiy fhstary ac SPK

• Zkeklt Utramk• Edr`hapuigaldry

cdhiurk

• Hggajhihty < 5 `dys

• Sdrheask vkhls• Ajkshty


9/74

^fy caeus al SPK1

• SPK hs (gastiy) prkvkltdjik


10/74


11/74

SPK Ufaui` LAP jk Ealsh`krk` d

’Lkvkr Kvklt‗

• Lat DII kvklts drk prkvkltdjik

• SPK aeeurs kvkl hl pdthklts rkekhvhlnjkst prdethek prapfyidxhs

• 6 ZEPs ac SPK Rrapfyidxhs hl OahltZkpidekgklt Uurnkry (0 PMD, 0 PFZ)

• 2.5%-:.;% Uygptagdthe SPK

Utrkhcc & Fdut, ODGD :228


12/74


13/74

Nklkrdi Dppradefks ta

SPK Rrapfyidxhs

• Rfdrgdeaianhe ― Fkpdrhl (h.k. ulcrdethaldtk`, IG^F) ― Shtdghl M dltdnalhsts (h.k. wdrcdrhl)

― Cdetar Vd hlfhjhtars (h.k. Zhvdraxdjdl) ― @hrket tfragjhl hlfhjhtars (h.k. @djhndtrdl) ― Dsphrhl

• Gkefdlhedi

― Ukquklthdi Eagprksshal @kvheks (UE@s) ― Eagprksshal Utaemhlns

• Hlckrhar Skld Edvd (HSE) Chitkrs• Dgjuidthal 111


14/74

Kvh`klek Jdsk`

SPK Rrapfyidxhs Nuh`kihlks

• Dgkrhedl Eaiiknk ac Efkst Rfyshehdls (DEER)• Dgkrhedl Eaiiknk ac Rfyshehdls (DER)• Kdstkrl Dssaehdthal car tfk Uurnkry ac Prdugd

(KDUP)• Dgkrhedl Ded`kgy ac Artfapk`he Uurnkals

(DDAU)• Dgkrhedl Eaiiknk ac Ajstktrhehdls dl`

Nylkeaianhsts (DEAN)• Ldthaldi Hlsthtutk car Fkditf dl` Eihlhedi

Kxekiiklek (LHEK)


15/74

@SP Rrapfyidxhs hs Sdstiy

[l`kruthihzk`!


16/74

• 36,465 pdthklts• 5;6 fasphtdis hl 5: eaultrhks

• Rrapfyidxhs

• ;6.; % eagpihdlek - surnhedi pdthklts

• 58.; % eagpihdlek - gk`hedi pdthklts

Eafkl, Idlekt :226


17/74

@SP? D`vdlehln Dwdrklkss ta RratketRdthklt Ihvks

Dgkrhedl Rujihe

Fkditf Dssaehdthal(DRFD)^fhtk Rdpkr :225


18/74

Dnkley car Fkditfedrk Zkskdref

dl` Tudihty (DFZT)

www.dfrq.nav


19/74

fttp?//www.dfrq.nav/rkskdref/chl`hlns/kvh`klek-

jdsk`-rkparts/skrvheks/qudihty/ptsdcktysug.p`c


20/74

• ’Utrdtknhks ta hlerkdsk dppraprhdtk

prapfyidxhs car SPK‗ hleiu`k` al ihst ac

tap 42 ’Utralniy Kleaurdnk` Rdthklt

Udckty Rrdetheks‗ fttp?//www.dfrq.nav/rkskdref/chl`hlns/

kvh`klek-jdsk`-rkparts/pdthkltsctyup`dtk/ptsdcktyHHefdp:6.p`c


21/74

• ’Ds whtf atfkr pdthklt sdckty hltkrvklthals,

k`uedthln pravh`krs al tfk jklkchts ac

dppraprhdtk SPK prapfyidxhs dialk hs lat dlkcckethvk strdtkny ta hgpravk dppraprhdtk usk acSPK prapfyidxhs.‗

fttp?//www.dfrq.nav/rkskdref/chl`hlns/

kvh`klek-jdsk`-rkparts/pdthkltsctyup`dtk/ptsdcktyHHefdp:6.p`c


22/74

Edl d Uystkgs Dppradef Hgpravk

SPK Rrkvklthal dl` Auteagks1


23/74

^fdt dppradefks edl hgpravk

SPK prapfyidxhs 1

• ’Rdsshvk `hsskghldthal ac nuh`kihlks hsulihmkiy ta hgpravk SPK prapfyidxhsprdethek.‗

• ’D lugjkr ac dethvk strdtknhks usk`tanktfkr, wfhef hlearpardtk sagkgktfa` car rkghl`hln eihlhehdls ta dssksspdthklts car @SP rhsm dl` dsshsthln tfkskikethal ac dppraprhdtk prapfyidxhs, drkihmkiy ta rksuit hl tfk defhkvkgklt acapthgdi auteagks.‗

Paafkr, D Uystkgdthe Zkvhkw ac Utrdtknhks ta Hgpravk Rrapfyidxhs

car Sklaus Pfragjakgjaihsg hl Fasphtdis. Dll Uurn :22;.


24/74

Hgpravhln SPK Rrapfyidxhs dt Oafls

Fapmhls Fasphtdi

Utrkhcc, JGO :24:


25/74


Fapmhls Fasphtdi

• Jkndl whtf Rdpkr ar`kr sfkkts tapravh`k eihlhedi `kehshal suppart

Utrkhcc, JGO :24:


26/74

Utrkhcc, JGO :24:

Hgpravhln

SPK

Rrapfyidxhs

dt Oafls

Fapmhls

Fasphtdi

Rdpkr


27/74


Fapmhls Fasphtdi

• Gdl`dtary SPK rhsm strdthchedthal taaihlta tfk eagputkrhzk` pravh`kr ar`kr

kltry (ERAK) systkg• D`vdlek` eagputkrhzk` eihlhedi

`kehshal suppart (E@U)

Utrkhcc, JGO :24:


28/74

:2 @hcckrklt Ukrvhek Upkehche Eihlhedi

Dinarhtfgs

• Artfapk`he Uurnkry

• Nklkrdi Uurnkry

• Prdugd• Gk`hehlk

• Edr`hde Uurnkry

• Ataidrylnaiany• Lkuraiany

• Lkurasurnkry

• Ajstktrhes

• Nylkeaianhe Aleaiany• Gk`hedi Aleaiany

• Rsyefhdtry

• Rk`hdtrhes• Rk`hdtrhe Uurnkry


29/74

Nklkrdi Uurnkry SPK Rrapfyidxhs

Dly EALPZDHL@HEDPHALU ta

pfdrgdeaianhe prapfyidxhs1

Fhnf rhsm ac jikk`hln Dethvk jikk`hln

Uystkghe dltheadnuidthal

HLZ ≫ 4.; ar dRPP rdtha ≫ 4.5

Ridtkikt eault 9 ;2,222

Xks

PK@s/UE@s

[sk gkefdlhedi prapfyidxhs

ulthi ealtrdhl`hedthal la ialnkr

prksklt. Zkvhkw pdthklt stdtus `dhiy

Dly Ghlar SPK rhsm cdetars1

Deutk Hlckethal/Ukpshs

Jk` rkst

Ekltrdi vklaus edtfktkr

Kstrankls/Ukikethvk kstrankl

rkekptar gaùidtars (k.n., Pdgaxhckl)

Hlcidggdtary jawki `hskdsk

Ga`krdtk Zhsm SPK Ar`krs

Fkpdrhl ;222 ulhts se q4:f

(Nhvk chrst àsk : frs. prk-ap

dl` tfkl jknhllhln 4:-:0 faurs

past-ap)^htf apthal ta D@@

PK@s/UE@s

Skry fhnf rhsm SPK ar`krs

Fkpdrhl ;222 ulhts se q6f


dl` tfkl jknhllhln

4:-:0 faurs past-ap)

Rius

PK@U/UE@s

Xks

La

Skry fhnf rhsm SPK ar`krs


(Nhvk chrst àsk : frs. prk-ap dl` tfkl

jknhllhln 4:-:0 faurs past-ap)

Rius

PK@U/UE@

Klaxdpdrhl 02gn se q@dy

(Chrst àsk : faurs prk-ap dl` tfkl

4:-:0 faurs past-ap)

(Zkgavk kphùrdi edtfktkr dt ld`hr (:2-:: frs.)

ac dltheadnuidlt kccket dl` wdht dt ikdst : faursdctkr edtfktkr rkgavdi ta rkàsk)

Rius

PK@U/UE@s

La

Xks

Erkdthlhlk eikdrdlek

9 52 gi/ghl ar

ulstdjik rkldi culethal

(patklthdi car ErEi ta

@keihlk jkiaw 52gi/ghl

ùrhln tfkrdpy)

Dly Gdoar SPK rhsm cdetars1

Rrkvhaus SPK

Edlekr

Pfragjapfhihd

Rraialnk` praekùrk (< : frs.) LXFD Eidss HHH/HS Fkdrt Cdhiurk

Zksphrdtary cdhiurk rkquhrhln

gkefdlhedi vklthidthal

Deutk Utramk whtf pdrkshs (9 5 gas.)

Rrknldley/past-pdrtug (up ta 3 wkkms)

La

Dnk < 321

Xks

Dnk ≫021

La

Fhnf rhsm SPK ar`krs



dl` tfkl jknhllhln 4:-:0 faurs

past-ap)

^htf Apthal ta d``

PK@U/UE@

La

Xks

La

Xks



Fhnf rhsm ac jikk`hln

Dethvk jikk`hln




La

PK@s/UE@s

[sk gkefdlhedi prapfyidxhs

ulthi ealtrdhl`hedthal la ialnkr

prksklt. Zkvhkw pdthklt stdtus `dhiy

Xks



Fhnf rhsm ac jikk`hln

Dethvk jikk`hln




Xks

La


30/74

Rdrklt ar`kr skt

@hcckrklt Ar`kr Ukts fdvk @hcckrklt SPK

Ga`uiks. [sk hs Gdl`dtary hl RAK warmciaw.


31/74

Dttkgpthln ta ulefkem tfk ar`kr

nhvks djavk gkssdnk


32/74

Dnk hs `hrketiy hgpartk`

crag `dtdjdsk


33/74

Gdl`dtary efahek

crag kdef skethal car

rhsm cdetars dl`

ealtrdhl`hedthals


34/74

Zhsm strdthchedthal dl`prapfyidxhs rkeaggkl`dthal

@ t th c Zh m Ut thch th ` R f i h A ` `


35/74

@aeugkltdthal ac Zhsm Utrdthchedthal dl` Rrapfyidxhs Ar`krk`


36/74

• Djaut :; ehtdthals pkr ykdr

• ODGD, Dll Uurn, JGO, Efkst, RiasAlk,

Ehreuidthal, EEG, Fkditf Dccdhrs

Aur Crdgkwarm car Efdlnhln

Rrdethek


37/74


38/74


39/74


40/74


41/74


42/74

Mkys ta Uueekss

• Guith`hsehpihldry tkdg

― Rfyshehdls, Lursks, Rfdrgdehsts, Hlcargdthes

• Ikd`krsfhp juy-hl

• Eaiidjardtk whtf skrvhek tkdgs

• K`uedtk cralt-ihlk pravh`krs

• Gkdsurk jdskihlk pkrcargdlek

• Eal`uet alnahln pkrcargdlek kvdiudthals

Utrkhcc, JGO :24:


43/74

Jklkchts ac tfk Eagputkrhzk` SPK

Rrkvklthal Uystkg

• Ruts SPK prkvklthal hlta tfk warm ciaw

• Kldjiks rdph`, deeurdtk rhsm strdthchedthal

dl` rhsm-dppraprhdtk SPK prapfyidxhs

• Dppihks kvh`klek `hrketiy ta eihlhedi edrk

• Diiaws car pkrcargdlek galhtarhln/rkparthln

• Cdehihtdtks rdph` trdlsidthal ac rkskdrefchl`hlns `hrketiy hlta eihlhedi edrk

Utrkhcc, JGO :24:


44/74

SPK Rrapfyidxhs-

Eagputkrhzk` @kehshal Uuppart

00www.ldtcalihlk.arn


45/74

@aks Hgpravhln Rrapfyidxhs Efdlnk

Auteagks1

• ^k tfaunft wk wkrk hlerkdshln qudihtydl` hgpravhln pdthklt edrk

• Jut eaui` wk sfaw fdr` `dtd1


46/74


Auteagks1

•XKU

•: kxdgpiks ―Oafls Fapmhls Prdugd Uurnkry ―Oafls Fapmhls Hltkrldi Gk`hehlk


47/74


Auteagks1 Pfk OFF Prdugd Kxdgpik

Fdut, Dref Uurn :24:


48/74



• Uhlnik Ekltkr (Oafls Fapmhls Fasphtdi)

• Rrk/Rast Hltkrvklthal Utu`y

• 4-ykdr RZK vs. 5-ykdrs RAUP

• Zktraspkethvk `dtd eaiikethal

• HZJ dppravk`



49/74



• Rrhgdry Auteagk

― Dppraprhdtk SPK ar`kr eagpihdlek

• Ukeal`dry Auteagks ― Dii SPK

― ’Rrkvkltdjik fdrg crag SPK‗



50/74





51/74

• Uhnlhchedlthlerkdsk hl SPK

prapfyidxhs• Uhnlhchedlt `rap

hl prkvkltdjik

fdrg crag SPK• 4.2% vs. 2.4>%

(p72.20)


3:.:%

60.0%




52/74


Auteagks1 Pfk OFF Gk`hehlk Kxdgpik

_kh`dl, Dg O Fkgdtaiany :245


53/74


• Zktraspkethvk Zkvhkw (RZK v. RAUP)

• Rdthklts ? 4,222 RZK v. 80: RAUP

• Rdthklts prkserhjk` Apthgdi Rrapfyidxhs

― 3;.3% v. 82.4% (p92.2224)

• Rdthklts prkserhjk` LA prapfyidxhs

― :5.3% v. 0.0% (p92.2224)




54/74





55/74


_KZA Rrkvkltdjik SPK ―

D Zkdihsthe Nadi


56/74

Rrajikg whtf Eurrklt ’Utdtk ac tfk Drt‗

SPK Gkdsurks

• SPK rdtks dialk drk lat truiy hl`hedthvk acqudihty ac edrk


57/74

Uurvkhiidlek Jhds dl` Rujihe

Zkparthln ac SPK


58/74

Ealcihet Avkr @upikx Uerkklhln

car dsygptagdthe @SP hl Prdugd

• Ealcihethln `dtd al kcchedey dl` east-kcckethvklkss ac `upikx serkklhln ac

dsygptagdthe trdugd pdthklts• Rra? H`klthcy @SP kdriy diiawhln trkdtgklt

jkcark cdtdi RK

• Eal? Idrnk kxpklsk, lat east kcckethvk,fdrg crag dltheadnuidthal


59/74

Dgkrhedl Eaiiknk ac Efkst

Rfyshehdls (DEER) Nuh`kihlks

• ’Car gdoar trdugd pdthklts, wk

sunnkst tfdt pkrha`he survkhiidlek whtf

vklaus eagprksshal uitrdsalanrdpfysfaui` lat jk pkrcargk` (Nrd`k :E).‗

Naui`, EFKUP :24:


60/74

Kdstkrl Dssaehdthal car tfk Uurnkry

ac Prdugd (KDUP) Nuh`kihlk

• ’Ukrhdi `upikx uitrdsaul` hgdnhln ac

fhnf-rhsm dsygptagdthe trdugd pdthklts

ta serkkl car @SP gdy jk east-kcckethvkdl` `kerkdsk tfk hleh`klek ac RK.‗

fttp?//www.KDUP.arn/rksaureks/trkdtgklt-nuh`kihlksZankrs, O Prdugd :22:


61/74

D Eidsshe Kxdgpik ac

Uurvkhiidlek Jhds

• Rravh`krs wfa serkkl garkdnnrksshvkiy jy pkrcarghln gark `upikx

uitrdsaul`s gdy h`klthcy gark edsks ac@SP dl` dppkdr ta pravh`k warskqudihty ac edrk tfdl tfask pravh`krs wfa

ar`kr ckwkr tksts


62/74

Uurvkhiidlek Jhds’[lgdsmhln‗ / ’@ktkethal Uhnldi‗ Jhds

• Aeeurs wfkl sagk pdthklts drkcaiiawk` up gark eiaskiy ar fdvk gark

`hdnlasthe tksts pkrcargk` tfdl atfkrs,actkl ikd`hln ta dl auteagk `hdnlask`gark crkqukltiy hl tfk gark eiaskiy

galhtark` nraup

Udemktt @I. Jhds hl dldiythe rkskdref.O Efralhe @hs. 48>8=5:(4-:)?;4-35


63/74

2

:

0

3

6

42

2

:2

02

32

62

422

Jkcark (488;-488>) Dctkr (4888-:22;) @ S P / R K Z

d t k p k r 4 2 2 2 P r d

u g d

D ` g h s s h a l s

@ u p i k x Z

d t k p k r 4 2 2 2 P r d u g d

D ` g h s s h a l s

Jkcark Ss. Dctkr Rkrha`s

@upikx @SP RK

Uhlnik Ekltkr (OFF)- @upikx & @SP rdtks

Jkcark v. Dctkr Uerkklhln Nuh`kihlk

6:

2.>

:4

* **>

p92.2224

p72.22:0Fdut, O Prdugd :22>


64/74

Fdut, O Prdugd :22>


65/74

Guith-Ekltkr (LP@J)- Fasphtdi Ikvki

@upikx & @SP rdtks

• Prdugd ekltkrs whtf fhnfkr rdtks ac`upikx uitrdsaul` rkpart fhnfkr @SPrdtks ta tfk Ldthaldi Prdugd @dtd Jdlm

Rhkrek, O Prdugd :226


66/74

Pfk Gark ^k Iaam, Pfk Gark ^k Chl`

Rhkrek, Fdut, kt di.O Prdugd

:226

>-cai` fhnfkr @SP rdtk dt

fasphtdis hl tap qudrthikac `upikx uitrdsaul`s


67/74

FasphtdiUerkklhln

Utdtus hs dl

Hl`kpkl`klt

Zhsm Cdetar

car @SP

Zkparthln

Fdut,O Prdugd :228

U hii Jh


68/74

Uurvkhiidlek Jhds

• @hcckrkleks hl auteagks gdy jk rkidtk` tasurvkhiidlek jhds rdtfkr tfdl `hcckrkleks hl qudihty

• ^kii-mlawl ealekpt hl kph`kghaiany• Uki`ag ealsh`krk` hl pujihsfk` eihlhedi stu`hks

Fdut & Rralavast, ODGD :244

H ih th


69/74

Hgpihedthals

Sdrhdjhihtyhl @SP

Uerkklhln

Sdrhdjhihtyhl @SPZdtks

Zkpartk`

Jhdsk`@SP

Zdtks


@ ch h R t ji F


70/74

@kchlhln Rrkvkltdjik FdrgPfk SPK Kxdgpik

• ^k sunnkstk` tfdt ’pkrcargdlekgkdsurks eaui` ihlm d praekss ac edrkwhtf d`vkrsk auteagks wfkl `kchlhlnhleh`kleks ac prkvkltdjik fdrg‗


Rrkvkltdjik Fdrg 7

SPK + La Rrapfyidxhs


71/74

Demlawik`nkgklts

Z f E ii j t


72/74

Zkskdref Eaiidjardtars

• SPK eaiidjardthvk• Utrkhcc, Fajsal, Mrdus, Idu, Ufkrgaem,

Ufdcckr, Ufhfdj, Edraidl, _kh`dl• Drgstraln Hlsthtutk• Rralavast, Jkrklfaitz, @kgsmh, Faizgukiikr

• @hvhshal ac Deutk Edrk Uurnkry

• Kcral, Fdh`kr, Utkvkls, Efh, Zusfhln,Skiapuias, Earlwkii, Ueflkh`kr, Ndrehd

• Kvh`klek Jdsk` Rrdethek Ekltkr• Ukndi, Uhlnf, Jratgdl, Mkjk`k

C `h


73/74

Cul`hln

• Dnkley car Fkditfedrk Zkskdref dl` Tudihty

(DFZT) (M26)

― ’@aks Uerkklhln Sdrhdjhihty Gdmk @SP dl [lrkihdjik

Tudihty Gkdsurk ac Prdugd Edrk1‗ • Rdthklt-Ekltkrk` Auteagks Zkskdref Hlsthtutk

(REAZH)

― ’Rrkvklthln Sklaus Pfragjakgjaihsg? Kgpawkrhln

Rdthklts dl` Kldjihln Rdthklt-Ekltkrk` Edrk vhdFkditf Hlcargdthal Pkeflaiany‗

• Uaggkr Uefaidrs (Oafls Fapmhls Jiaagjkrn

Uefaai ac Rujihe Fkditf)

T th 1


74/74

Tuksthals1

• Kiihatt Z. Fdut, G@, CDEU

• Tuksthals - kfdut4Bofgh.k`u

• Gark Hlca- www.gk``hug.eag/kfdut
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HAUT HMV Brazil Grand Rounds April 29 2014

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Transcript of HAUT HMV Brazil Grand Rounds April 29 2014