The rescuer must bring the victim to the surface by grabbing either (or both) of the victims arms and swimming upward, which may entice the victim to travel in the same direction, thus making the task easier, especially in the case of an unconscious victim. Should the victim be located in deeper waters (or simply complicates matters too much) the rescuer should dive, take the victim from behind, and ascend vertically to the water surface holding the victim. After a successful contact with the victim, any ballast (such as weight belt) should be discarded. Finally, the victim must be taken out of the water, which is achieved by a towing maneuver. This is commonly done placing the victim body in a face-up horizontal position, passing one hand under the victims armpit to then grab the jaw with it, and towing by swimming backwards. The victims mouth and nose must be kept above the water surface. If the person is cooperative, the towing may be done in a similar fashion with the hands going under the victims armpits. Other styles of towing are possible, but all of them keeping the victims mouth and nose above the water. Unconscious people may be pulled in an easier way: pulling on a wrist or on the shirt while they are in a face-up horizontal position.
Immune
Variations in genes that are part of the immune system or part of melanocytes have both been associated with vitiligo. It is also thought to be caused by the immune system attacking and destroying the melanocytes of the skin. A genome wide association study found approximately 36 independent susceptibility loci for generalized vitiligo. Autoimmune associations
Vitiligo is sometimes associated with autoimmune and inflammatory diseases such as Hashimotos thyroiditis, scleroderma, rheumatoid arthritis, type 1 diabetes mellitus, psoriasis, Addisons disease, pernicious anemia, alopecia areata, systemic lupus erythematosus, and celiac disease.Among the inflammatory products of NALP1 are caspase 1 and caspase 7, which activate the inflammatory cytokine interleukin-1β. Interleukin-1β and interleukin-18 are expressed at high levels in people with vitiligo. In one of the mutations, the amino acid leucine in the NALP1 protein was replaced by histidine (Leu155 → His). The original protein and sequence is highly conserved in evolution, and is found in humans, chimpanzee, rhesus monkey, and the bush baby. Addisons disease (typically an autoimmune destruction of the adrenal glands) may also be seen in individuals with vitiligo. Diagnosis
An ultraviolet light can be used in the early phase of this disease for identification and to determine the effectiveness of treatment. Using a Woods light, skin will change colour (fluoresce) when it is affected by certain bacteria, fungi, and changes to pigmentation of the skin. Classification
Classification attempts to quantify vitiligo have been analyzed as being somewhat inconsistent, while recent consensus have agreed to a system of segmental vitiligo (SV) and non-segmental vitiligo (NSV).