Factors associated with poor outcomes of hospitalized myasthenia gravis
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* Sim S. Tin
* Viroj Wiwanitkit

***To the Editor***

We would like to discuss the recent publication by Tiamkao et al1 entitled ‘Factors associated with poor outcomes of hospitalized myasthenia gravis’. Tiamkao et al1 noted that “hospital category, pneumonia, and respiratory failure” are the 3 main factors associated with poor outcome. Based on the nature of a retrospective study, there are some points to be addressed. First, it cannot exclude any possible concomitant illness in the studied cases. Also, the data on “cost” in the present study should be carefully analyzed, as there were a lot of changes in the currency value in Thailand during the studied period. In addition, many previous reports mentioned the variability of clinical outcome due to pathological underlying myasthenia gravis (thymomatous versus non-thymomatous), and the methods used for treatment (medical treatment, surgical manipulation, and other techniques).2 Finally, the role of underlying genetics should also be discussed. It is reported that patients with the HLA-B8-DR3 haplotype, especially among younger, female patients usually have more severe diseases.3

***Reply from the Author***

No reply received from the author.

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## References

1.  Tiamkao S, Pranboon S, Thepsuthammarat K, Sawanyawisuth K (2014) Prevalence of factors associated with poor outcomes of hospitalized myasthenia gravis patients in Thailand. Neurosciences 19, 286–290.
    
    

2.  Skeie GO, Romi F (2008) Paraneoplastic myasthenia gravis: immunological and clinical aspects. Eur J Neurol 15, 1029–1033.
    
    

3.  Fang F, Sveinsson O, Thormar G, Granqvist M, Askling J, Lundberg IE, et al. (2014) The autoimmune spectrum of myasthenia gravis: a Swedish population-based study. The autoimmune spectrum of myasthenia gravis: a Swedish population-based study. J Intern Med, doi: 10.1111/joim.12310.