Ichthyosis hystrix Ichthyosis hystrix Ichthyosis hystrix is a group of rare skin disorders in the ichthyosis family of skin disorders characterized by massive hyperkeratosis with an appearance like spiny scales. This term is also used to refer to a type of epidermal nevi with extensive bilateral distribution. The symptoms of ichthyosis hystrix Curth-Macklin are similar to epidermolytic hyperkeratosis (NPS-2 type) but there is no blistering and the hyperkeratosis is verrucous or spine-like. The hyperkeratosis is brown-grey in colour and is most obvious on the arms and legs. It is an autosomal dominant condition and can be caused by errors to the KRT1
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