X-linked ichthyosis X-linked ichthyosis X-linked ichthyosis (XLI) (also known as ") is a skin condition caused by the hereditary deficiency of the steroid sulfatase (STS) enzyme that affects 1 in 2000 to 1 in 6000 males. XLI manifests with dry, scaly skin and is due to deletions or mutations in the "STS" gene. XLI can also occur in the context of larger deletions causing contiguous gene syndromes. Treatment is largely aimed at alleviating the skin symptoms. The term is from the Ancient Greek 'ichthys' meaning 'fish'. The major symptoms of XLI include scaling of the skin, particularly on the neck, trunk, and
Emergency medical services in the Netherlands The exceptional level of training permits what is, for the most part, independent practice, conducted according to a set of National Emergency Care Protocols, issued by the Dutch Ambulance Institute, and reviewed and revised every four years. Medical oversight for protocol compliance is conducted by each service's Medical Manager, who is a licensed physician. On those occasions when the patient's condition actually exceeds the paramedic protocols, the paramedic has the option of either calling their own Medical Manager for additional instructions, or requesting the response of a mobile medical team. All ambulances are staffed by a crew of two. These