Health and healthcare disparities are variances in the health of a population or the care rendered to a population. Disparities result in a disproportionately higher prevalence of disease or lower standard of care provided to the index group. Multiple theories exist regarding the genesis of this disturbing finding. The COVID-19 pandemic has had the unfortunate effect of amplifying health inequity in vulnerable populations. African Americans, who make up approximately 12% of the US population are reportedly being diagnosed with COVID-19 and dying at disproportionately higher rates. Viewed holistically, multiple factors are contributing to the perfect storm: 1) Limited availability of public testing, 2) A dramatic increase in low wage worker unemployment/health insurance loss especially in the service sector of the economy, 3) High rates of preexisting chronic disease states/reduced access to early healthcare and 4) Individual provider and structural healthcare system bias. Indeed, COVID-19 represents a pandemic superimposed on a historic epidemic of racial health inequity and healthcare disparities. Therapeutic solutions are not expected in the near term. Thus, identifying the genesis and magnitude of COVID-19's impact on African American communities is the requisite first step toward crafting an immediate well designed response. The mid and long term approach should incorporate population health based tactics and strategies.

Growth rates of PAA were heterogeneous but were optimally predicted by multilevel modelling. Patients with an existing AAA may have faster PAA progression than those without.

A series of 245 patients was operated upon for abdominal aortic aneurysm during the years 1969-77, of whom 162 were elective cases while in 83 the aneurysm was leaking or had ruptured. The hospital mortality for the latter group fell from 77 per cent at the beginning of the study period to 30 per cent at the end. For elective operations, hospital mortality averaged 9.3 per cent, though during the last 2 years there were no deaths in the 51 consecutive cases. Operative methods and postoperative treatment changed during the years of the study, with few excision-replacement grafts and greater use of the inlay technique, most of the latter being simple unbranched Dacron tubes. Early graft infection, the most important and serious surgical complication, caused 9 deaths, an overall incidence of 3.7 per cent, of which 8 were in patients who received no perioperative antibiotics and only 1 among the patients who did receive them. All deaths were in the inlay group. The reasons for this are discussed. Since July 1976 perioperative antibiotic treatment has been routine for all arterial prosthetic graft patients in our hospital.

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A 46-year-old self-employed property developer, under surveillance for a thrombosed left dorsalis pedis artery (DPA) secondary to impingement, presented with a 4-month history of discomfort and numbness of the right foot. Symptoms were most marked whilst kneeling (Panel A). He had no other co-morbidities, although he weighed 123 kg. On examination, pallor of the plantar aspect of the left foot was evident after a period of standing, despite angiographic evidence of a patent posterior tibial artery and medial and lateral plantar arches. Magnetic resonance angiography of both legs in the neutral position demonstrated no significant disease of vessels proximal to the foot. Duplex ultrasound imaging of the right foot in the neutral position demonstrated patency of the DPA with a triphasic waveform (Panel B; pre-operative). Plantar flexion of the right foot highlighted signs of entrapment and forced plantar flexion resulted in complete cessation of flow, features which resolved on neutralizing these manoeuvres. Operative intervention was undertaken. Thickened tissue bands were divided deep to the tendon of the extensor hallucis brevis (EHB), which appeared to be compressing the DPA on extreme plantar flexion. Exostosis of the talus was also removed, as it was causing bow stringing of the DPA, which was amplified on plantar flexion (Panel C). The patient recovered with complete resolution of symptoms. Surveillance duplex ultrasonography of the right foot at 6 months demonstrated normal triphasic antegrade flow in the DPA (Panel B; post-operative).Primary vascular atherosclerotic disease is rare in young adults. Symptoms related to anatomical positioning in this patient group should prompt assessment for extra-vascular anatomical impingement. To date, causes described have been limited to the encroachment of the EHB tendon running superficial to the DPA or anomalous fibrous bands. 1,2 These anatomical features are the consequences of intense physical activity leading to overuse injury and remodelling. We present a case of bilateral dorsalis pedis impingement, which is unique in highlighting bony remodelling to compromise the passage of the DPA. Our case, along with the case described by Smith et al., implicates occupation to be a potential risk factor leading to the development of dorsalis pedis entrapment syndrome. 1 There also appears to be a tendency towards developing bilateral impingement, which is exemplified by existing case reports. 1,2 This case highlights the importance of surveillance in patients with unilateral impingement so that contralateral impingement may be identified early and corrective surgery undertaken to prevent complications and subsequent lifestyle limiting symptomology.