INTRODUCTION: Atopic dermatitis (AD) is a prevalent chronic inflammatory skin disorder in children. Moderate-to-severe cases often remain uncontrolled with conventional therapies. Advances in type 2 immunopathogenesis have enabled the development of biologic agents targeting key cytokines.EVIDENCE ACQUISITION: We conducted a narrative review of studies published up to August 2025, including randomized controlled trials, open-label extensions, observational studies, and systematic reviews on biologics in pediatric AD.EVIDENCE SYNTHESIS: Dupilumab, blocking IL-4Rα, has robust evidence across all pediatric ages. Tralokinumab and lebrikizumab (anti-IL-13) show efficacy in adolescents, with ongoing studies in younger children. Nemolizumab (anti-IL-31RA) provides rapid antipruritic effects but more modest skin clearance. Upstream inhibitors such as tezepelumab (anti-TSLP), etokimab, and itepekimab (anti-IL-33) are investigational. Compared with biologics, JAK inhibitors offer oral delivery but require stricter safety monitoring. Real-world data confirm effectiveness and tolerability, though access remains uneven.CONCLUSIONS: Biologics represent a milestone in pediatric AD management, combining sustained efficacy and favorable safety. Future priorities include long-term safety studies, biomarker-guided treatment, and equitable access strategies.

BACKGROUND: Few tools assess motivation for nature-based physical activity (PA), with the PA and Leisure Motivation Scale (PALMS) and the Motivations for Nature-Connectedness Questionnaire (MNQ) addressing this gap. This study validated these tools in Italian and explored adolescents’ motivations for green exercise.METHODS: A cross-sectional validation study was conducted as part of the “IFormaMentis” project with Italian adolescents. The sample included students who engaged in vigorous/moderate PA twice a week. Motivational differences were analyzed between those practicing outdoor activities frequently (ASO) and those doing so less than twice a week (ASIO).RESULTS: PALMS-IT (α=0.980) and MNQ-IT (α=0.815) showed strong reliability. The study included 760 students, 88% of whom were active twice a week. A significant gender difference was found, with males being more active and more likely to participate in outdoor activities. The ASIO group showed greater motivation for appearance, physical condition, mastery, and enjoyment compared to ASO+ASIO. In contrast, ASO+ASIO participants showed higher motivation related to psychological condition.CONCLUSIONS: PALMS-IT and MNQ-IT effectively assess motivations for outdoor PA. Psychological condition, enjoyment, and mastery play key roles in sustaining PA, emphasizing the importance of emotional factors. The study also highlights a lasting impact of pandemic restrictions on adolescents’ PA choices. These findings offer policymakers and educators new avenues for promoting green activity among adolescents.

Perinatally transmission of human immunodeficiency virus type-1 (HIV) is the first cause of pediatric HIV infection. Thanks to advances in highly active antiretroviral therapy (ART), HIV-vertically infected children have overall longer survival and better quality of life expectancy. Consequently, in the near future physicians need to face with an increasing number of cardiovascular complications related to the long-term toxicity of ART. The purpose of this review was to delve into this unique cohort of patients analyzing the effect of ART on vascular system, metabolism and heart structure, the latter including a special in-depth analysis into fetal life. Understanding the link between ART and cardiovascular risk in this population is highly relevant to clinical practice; knowing the potential cardiovascular adverse effects is critical for balancing the benefits of viral suppression with the risks of long-term cardiovascular damage. We aimed to review the current literature to analyze the influence of vertically acquired HIV infection and ART therapy over the pathophysiological, clinical and echocardiographic features of affected patients. Although considerable progress has been made in understanding the natural history of HIV infection, there is still a consistent gap in early detection and management of long-term cardiovascular effects of ART and lack of specific risk scores/guidelines for affected children. The ability to recognize and monitor these complications is essential for healthcare providers. It enables early intervention, informed treatment decisions and risk stratification, particularly when selecting ART regimens for children with predisposing factors or comorbidities. Furthermore, this knowledge supports the integration of cardiovascular monitoring into routine pediatric HIV care and promotes interdisciplinary collaboration between infectious disease specialists, cardiologists and pediatricians. Ultimately it enhances patient safety, improves quality of life and underscores the importance of long-term follow-up and preventive medicine in managing chronic conditions in pediatric HIV care.

Asthma is a chronic, heterogeneous disease characterized by airway inflammation, hyperresponsiveness, and obstruction, with varying grade of severity and a wide range of clinical manifestations. Biomarkers have emerged as valuable tools in supporting the diagnosis and management of pediatric asthma, particularly in identifying certain disease phenotypes and endotypes such as Type 2 (T2)-high asthma and T2-low asthma. However, their use should be context-specific, as not all biomarkers are sufficiently precise or validated for diagnostic or treatment-monitoring purposes in every pediatric case. For T2-high asthma, biomarkers such as blood eosinophils, fractional exhaled nitric oxide (FeNO), and IgE are well-established indicators of eosinophilic inflammation. Elevated FeNO and eosinophil counts correlate with inflammation severity, while IgE levels guide treatment with anti-IgE therapies, such as omalizumab. Additionally, periostin has shown promise in predicting responses to monoclonal antibodies in severe asthma. Conversely, T2-low asthma, characterized by neutrophilic or paucigranulocytic inflammation, lacks well-defined biomarkers. Neutrophil counts in sputum and blood, as well as cytokines like IL-6, IL-8, and IL-17, are emerging indicators of inflammation. Elevated levels of Chitinase-3-like protein 1 (YKL-40) and vascular endothelial growth factor (VEGF) also suggest roles in airway remodeling and inflammation, particularly in non-T2 asthma. Innovations in omics technologies (genomics, transcriptomics, proteomics, and metabolomics) have revolutionized biomarker discovery, enabling the identification of specific molecular signatures. Omics approaches offer promising opportunities for non-invasive analysis and the development of precision medicine strategies, especially for managing pediatric asthma. Despite advancements, challenges persist in addressing T2-low asthma and optimizing biomarker-based approaches. Further research is essential to refine biomarkers, improve phenotyping, and enable personalized therapies, ultimately enhancing outcomes and quality of life for children with asthma.

INTRODUCTION: Pectus excavatum (PE) is a common congenital chest wall deformity that can impact physical and psychological health. Effective management often involves a combination of surgical and non-surgical treatments, including physiotherapy. This review aims to assess the current literature on rehabilitative approaches for adolescents and children with PE to identify elective treatments.EVIDENCE ACQUISITION: This scoping review followed the Joanna Briggs Institute (JBI) methodology for scoping reviews, employing systematic database searches across MEDLINE, Cochrane Central, Scopus, and PEDro. A two-stage study selection was conducted, with disagreements resolved by a third reviewer. Data extraction followed a thematic synthesis approach, focusing on conservative and surgical treatments for pectus excavatum.EVIDENCE SYNTHESIS: The review included a diverse range of studies with varying methodologies and sample sizes. Physiotherapy, combined with conservative treatments like the vacuum bell, showed significant improvements in lung function, physical fitness, and quality of life. Surgical interventions, particularly the minimally invasive Nuss procedure, demonstrated effective long-term outcomes with early postoperative rehabilitation enhancing recovery. Accurate diagnosis and classification using tools like the Haller index and anthropometric index were critical for selecting appropriate treatments.CONCLUSIONS: Physiotherapy plays a crucial role in the management of PE, especially when combined with conservative treatments. Early postoperative rehabilitation following surgical interventions like the Nuss procedure significantly improves functional outcomes. However, there is a need for high-quality randomized controlled trials to establish definitive guidelines. A multidisciplinary approach, incorporating accurate diagnostic tools and tailored rehabilitative programs, is essential for optimizing treatment outcomes and improving the quality of life for adolescents and children with PE.

The aim of this study was to determine whether there was an association between platelet parameters and the presence of pulmonary hemorrhage (PH) in very low birth weight infants. Fifty preterm infants who developed PH with gestational age ≤30 weeks and birth weight ≤1500 g were analyzed retrospectively. The infants with PH were matched for gestational age and birthweight with infants without PH, who served as control group. Groups were compared in terms of demographic, clinical characteristics and for the platelet parameters. Red cell distribution width to platelet ratio (RPR) and platelet mass were also calculated. A total of 150 premature infants were analyzed in the study, including 50 infants with PH and 100 controls. In terms of platelet parameters, the PH group had significantly lower platelet count, mean platelet volume (MPV) and RPR (P=0.025, P<0.001, P=0.003; respectively). Multiple logistic regression analysis showed that respiratory distress syndrome (OR: 8.69; 95%[CI]: 2.71- 27.7; P<0.001) and MPV>8.1fL (OR: 2.60; 95% CI: 1.11-6.06; P=0.019) were independent risk factors for PH. Our data indicated that PH was associated with the presence of RDS and higher MPV in preterm infants.

The aim of this study was to evaluate the difference between symptomatic discoid lateral meniscus (DLM) and healthy knees in terms of gait analysis. A systematic review was conducted from the electronic databases PubMed/MEDLINE, EMBASE and Scopus. The review was performed on studies that reported data on kinematics, gait analysis, biomechanics in discoid lateral meniscus, before and after surgery. Out of 127 identified items, six full-text articles were assessed for eligibility. Three of these studies were included in the quantitative synthesis. Those studies reported a significantly slower gait speed and shorter stride length, smaller excursion during weight acceptance and mid-stance phases and during the whole gait cycle, smaller maximum flexion angle in swing phase, lower frontal excursion, smaller axial excursion in the DLM groups compared to the control groups. One study reported a significative increase in the walking speed and in the stride length, increase both in the maximum knee flexion angle during stance phase and swing phase, and in the range of flexion-extension after arthroscopic surgical treatment for symptomatic DLM. Literature about gait analysis on DLM patients is still very scarce and heterogeneous. The few studies on this topic show a different gait pattern between DLM knees and healthy knees and are encouraging about the surgical outcomes of DLM in terms of gait. Larger and standardized studies should be designed to assess a more suitable number of subjects with DLM.