In L-CDH, SP as described represents a simple indirect measurement of intrathoracic position and quantification of liver.

Objective: Fetal megacystis has a poor prognosis. During the first trimester, it is frequently associated with chromosomal abnormalities or multiple malformations, but can also be isolated and resolve spontaneously. In this study, our main objective was to determine the fetal and pediatric prognosis in this particular situation. Methods: This was a retrospective multicenter study. We describe the cases referred to our fetal medicine centers and also cases previously reported in the international literature. Results: Five cases were referred to our fetal medicine centers. After spontaneous resolution of megacystis, close ultrasound follow-up revealed urinary tract abnormalities in all cases. These abnormalities were all transient. After birth, 1 of the children developed a mild ureteropelvic junction obstruction. Pediatric follow-up was normal for the other children. Our 5 cases plus 79 in the literature mean that 84 cases of isolated first-trimester fetal megacystis with spontaneous resolution have been reported to date. The risk of chromosomal abnormality was 2.4% (2/84) and pediatric follow-up was normal in 96.4% of cases (81/84). Conclusion: Even when isolated first-trimester fetal megacystis resolves spontaneously, fetal karyotype analysis and close prenatal ultrasound follow-up should be performed. When there is no chromosomal abnormality, the renal pediatric prognosis seems to be good.

The societal and economic burden of chronic pain has been increasing in recent years, with a 2018 British Pain Society study estimating 8 million adults in the UK to be suffering from moderate to severely disabling chronic pain. The ongoing COVID-19 pandemic has exacerbated this issue, with massive increases in treatment waiting times and an increase in prevalence of persistent pain observed. As a result, the problems associated with chronic pain treatment mentioned earlier have only been further exacerbated by the ongoing COVID-19 pandemic. Recent rapid advance in technology have led to the emergence of digital clinics, an alternative healthcare delivery method. Several studies have shown the effectiveness of digital clinics on reducing waiting times, patient costs and increasing satisfaction levels. A survey conducted by Leva Clinic, UK's first CQC registered, fully research-led, centralised, digital and MDT led chronic pain clinic provided some insight into patient's views of treatment provided by digital pain clinics. Whilst feedback from patients and other studies have shown digital clinics to be a viable alternative of traditional clinics, it brings its own set of advantages and disadvantages. It is therefore paramount that clinics consolidate various aspects of current pain management practice and bring together MDT members to a single point of access to provide patients with treatment that unites the advantages of traditional and digital clinics. It is our hope and goal that with proper regulation and management, digital clinics should support reducing the global burden and prevalence of chronic pain.

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