Discussion on the Clinical Course of Adverse Effects after COVID-19 Vaccination: A Retrospective Analysis of Case Series in an Outpatient Department / 가정의학회지

Background@#A total of 8,303 individuals (4.3%) with adverse reactions (n=191,860) after vaccination developed serious conditions or died. Such health developments could cause people not vaccinated yet or waiting for a booster shot to become fearful of the vaccination. @*Methods@#The 3-month (July–September 2021) clinical data of 41 patients from the family medicine department of a single medical center were analyzed retrospectively to determine risk factors and to investigate the clinical course to identify the cause of symptoms in detail. @*Results@#A significant number of older adults aged over 50 years reported experiencing general weakness (P=0.026) but fewer incidences of fever than patients aged 50 years or younger (P=0.011). Eighteen of the 41 patients were requested to visit more than twice or consult a specialist. In 14 patients, the symptoms were explained by other medical causes. @*Conclusion@#The primary physician has a pivotal role in thoroughly evaluating patients who complain of adverseeffects after vaccination, considering the broad multitude of symptoms and medical conditions presented. To thoroughlyevaluate and appropriately advise patients with adverse reactions to their chosen vaccine, taking detailedmedical history and nutritional counseling are required to identify possible underlying causes, resolve symptoms,and educate them on self-care and regarding vaccines.

Association of Lung Function with Serum 25-Hydroxyvitamin D Level according to the Presence of Past Pulmonary Tuberculosis in Korean Adults / 가정의학회지

BACKGROUND: Vitamin D deficiency is associated with an increased risk of pulmonary tuberculosis (PTB) infection and the treatment outcome. The aim of this study was to examine the relationship between the serum 25-hydroxyvitamin D (25[OH]D) level and lung function in Korean adults according to whether or not there is a history of PTB. METHODS: The data for subjects aged 19 years or older from the Korea National Health and Nutrition Examination Survey 2008–2012 who underwent spirometry, chest radiography, and serum 25(OH)D level measurement were analyzed. RESULTS: Evidence of past PTB infection was found in 1,482 (9.6%) of 15,516 subjects. The serum 25(OH)D level was lower in the group with past PTB than in the non-PTB group (P=0.013). Respiratory dysfunction was more common in the past PTB group than in the non-PTB group (restrictive pattern, 14.0% vs. 9.6%; obstructive pattern, 29.6% vs. 8.2%; both P<0.001). After adjusting for age, sex, height, and season, the mean difference in forced expiratory volume in 1 second (FEV1) between the highest and lowest quartiles of 25(OH)D was 100.2 mL (standard error= 49.3 mL, P for trend=0.049) in the past PTB group and 34.7 mL (standard error=13.6 mL, P=0.009) in the non-PTB group. CONCLUSION: FEV1 tended to increase as the vitamin D quartile increased in both study groups. This relationship was more pronounced in subjects with a history of PTB. A higher serum 25(OH)D level might be beneficial in preserving lung function after PTB infection.

Medical students' and patients' perceptions of patient-centred attitude / 한국의학교육

PURPOSE: Patient-centred care can increase patient satisfaction and lead to better clinical outcomes for them, such as improved physical status and higher health-related quality of life. However, doctors' and patients' views on patient-centred attitude might differ and could be affected by culture and the community environment. To clarify the differences in primary care patients' and senior medical students' perceptions of medical students' patient-centred attitude. METHODS: A total of 1,025 subjects-827 patients from primary care institutions and 198 fourth-year medical students from a medical college in South Korea-completed the Patient Practitioner Orientation Scale (PPOS). The students completed the self-reported questionnaire at the end of their clinical clerkship. Descriptive statistics, t-tests, and one-way analysis of variances were conducted in SPSS version 21.0. RESULTS: Firstly, sharing subscale scores were higher among patients than among medical students (students, 3.61 vs. patients, 3.76; p<0.001), but secondly, caring subscale scores were higher among medical students (students, 4.18 vs. patients, 3.82; p<0.001). Thirdly, PPOS total scores were higher among medical students (students, 3.90 vs. patients, 3.79; p=0.001). Finally, male students had the lowest sharing scores (F=6.811, p<0.001) and female students showed the highest PPOS total scores (F=5.805, p=0.001). CONCLUSION: Significant differences between medical students' and patients' perceptions of medical students' patient-centred attitudes suggest the necessity of educational efforts to overcome the gap between the groups.

The Definition of Past Tuberculosis Affects the Magnitude of Association between Pulmonary Tuberculosis and Respiratory Dysfunction: Korea National Health and Nutrition Examination Survey, 2008–2012

Tuberculosis (TB) is associated with an increased risk of chronic lung impairment. The aim of this study was to compare the clinical characteristics and lung functions according to definition of past TB. We used the population-based, Korea National Health and Nutrition Examination Survey (KNHANES) (2008–2012) to analyze 13,522 subjects age 40 years or older who underwent spirometry and chest X-ray (CXR). Subjects with TB lesions on CXR (with or without a history of TB) were older, more likely to be male, ever smokers, and of low socioeconomic status than subjects with only a history of TB or without evidence of TB. Airflow obstruction (AFO) was associated with only a history of TB (odds ratio [OR] 1.53, 95% confidence interval [CI] 0.95–2.46), only TB lesion on CXR (OR 2.37, 95% CI 1.80–3.12), and both a history and TB lesions on CXR (OR 4.47, 95% CI 3.07–6.51) after adjustment for gender, age, body mass index, education, income, and smoking amount (P for trend < 0.001). Spirometric restriction was associated with only a history of TB (OR 1.29, 95% CI 0.80–2.08), only TB lesions on CXR (OR 2.03, 95% CI 1.49–2.76), and both a history and TB lesions on CXR (OR 2.65, 95% CI 1.74–4.05) after adjustment for the above variables (P for trend < 0.001). How to define past TB in population study affects the magnitude of association between past TB and respiratory dysfunction. Without considering TB lesions on CXR, the association between TB and respiratory dysfunction could be underestimated.

Factors Associated with Ketamine Use in Pancreatic Cancer Patient in a Single Hospice Center / 한국호스피스완화의료학회지

PURPOSE: Up to 90% of pancreatic cancer patients suffer from neuropathic pain. In a palliative care setting, pain control in pancreatic cancer patient is one of the major goals. Ketamine is a N-methyl-D-aspartate (NMDA) receptor antagonist, effective in neuropathic pain. Additionally, there have been studies about the opioid sparing effect of ketamine. This study was held in the palliative care unit among pancreatic cancer patients to determine the factors related to ketamine use and the opioid sparing effect. METHODS: The medical records of pancreatic cancer patients admitted to St. Mary's hospital palliative care unit between January, 2013 and December, 2014 were reviewed. Patients were divided into 2 categories according to ketamine use. Also, opioid use before and after ketamine use was compared in the ketamine group. RESULTS: Compared to the non-ketamine use group, patients in the ketamine group required a higher dose of opioid. The total opioid dose, daily opioid dose, number of daily rescue medications, and daily average rescue dose were statistically significantly higher in the ketamine group. The opioid requirement was increased after ketamine administration. CONCLUSION: In this retrospective study, ketamine was frequently considered in patients with severe pain, requiring higher amount of opioid. Studies about palliative use of ketamine in a larger number of patients with diverse types of cancer pain are required in the future.

Association between Respiratory Function and Albuminuria among Korean Male according to Smoking Status: The 2011 Korea National Health and Nutrition Examination Survey (KNHANES)

BACKGROUND: Several studies have found an association between decreased respiratory function and renal impairment in those with chronic kidney disease. The relationship has not been investigated for healthy smokers. The aim of this study was to examine the association between respiratory function and renal function according to smoking status in Korean male population. METHODS: From the 5th Korean National Health and Nutrition Examination Survey (KNHANES), we enrolled 1246 male participants who were 40 years or older. As a cross-sectional study, the association between respiratory function and renal function were analysed depending on the' smoking status. Pearson correlation analysis was used to find the association between respiratory function and renal impairment. Covariance Analysis allowed to compare renal function (albuminuria, eGFR) with respiratory function (FEV1, FVC) according to smoking status. RESULTS: Regardless of smoking status, there was a negative correlation between respiratory function (FEV1 and FVC) and urinary albumin to creatinine ratio (LogUACR), and positive correlation between respiratory function (FEV1 and FVC) and estimated glomerular filtration rate (eGFR). Smokers have lower FEV1 and FVC in case they have albuminuria, after adjusting for covariant (P=0.012, P=0.010, respectively). CONCLUSIONS: Respiratory function was significantly lower in male smokers with albuminuria. Primary care physicians need to recognize that albuminuria may accompany with decreased respiratory function and to detect renal function impairment earlier in male smokers.

Changes in the Degree of Patient Expectations for Patient-Centered Care in a Primary Care Setting / 가정의학회지

BACKGROUND: To date, the medical environment has been undergoing continual changes. It is therefore imperative that clinicians recognize the changing trends in the degree of patient expectations for patient-centered care. We conducted this study to examine changes in the degree of patient expectations for patient-centered care and the related socio-demographic factors in a primary care setting over a 5-year period. METHODS: We evaluated patients' attitudes toward patient-centered care using the Patient-Practitioner Orientation Scale, which provides 'sharing' and 'caring' scores. The study included 359 and 468 patients in phase I (March-July, 2005) and II (March-July, 2010). We also examined the relationship of their changes to their socio-demographic factors. RESULTS: In phase II, as compared with phase I, the 'sharing' score was higher (3.67 +/- 0.68 vs. 3.82 +/- 0.44; P < 0.001) and 'caring' one was lower (4.01 +/- 0.57 vs. 3.67 +/- 0.58; P = 0.001). Further, 'sharing' and 'caring' scores were associated with age, monthly income, education level, marital status, and the functional health status of patients. CONCLUSION: These results would be of help for providing patient-centered care for patients because it makes clinicians are aware of the degree to which patients' expect it.

Changes in medical students' patient-centeredness attitudes by implementation of clinical performance examination / 한국의학교육

PURPOSE: From 2009, the Korean Medical Licensure Exam implemented a clinical performance examination (CPX) that highlighted the importance of good patient-physician relationships in medical education. This study aimed to examine changes in medical students' attitudes before and after implementation of the CPX in their medical education curriculum. METHODS: In 2006 and 2009, 236 fourth-year medial students of C College of Medicine took the Patient Practitioner Orientation Scale (PPOS) by Krupet et al. (2000), which measures patient-centered attitudes in patient-physician relationships. The data were analyzed by independent t-test and two-way analysis of variance using SPSS 21.0. RESULTS: The PPOS scores of year 2006 students were 3.88+/-0.25 for males and 3.98+/-0.38 for females. For year 2009 students, males scored 3.81+/-0.42 and females scored 4.01+/-0.48. All students had higher Care scores than Share scores (2006: Share, 3.67+/-0.47 vs. Care, 4.19+/-0.51; 2009: Share, 3.56+/-0.34 vs. Care, 4.18+/-0.53). There were significant differences in PPOS and Share scores by gender before and after the CPX. With regard to Care scores, female students' scores tended to rise and males' scores declined over time. CONCLUSION: An educational program is needed for students to foster patient-centered attitudes, but gender differences should be taken into account.

Are Medical Students Satisfied with Their Medical Professionalism Education? / 한국의학교육

PURPOSE: This study aims to examine the satisfaction of undergraduate medical students with their medical professionalism education. METHODS: Two hundred and one premedical students and 1,287 medical students (from year 1 to 4) participated in a five-point Likert scale survey. There were 27 items in the premedical students' survey and 31 items in the medical students' questionnaire. Statistical analysis including one-way ANOVA was performed. RESULTS: Among the 27 items concerning premedical professionalism education, only six topics scored "average" level. In the survey of medical students only nine items out of 31 were rated "average" which did not reach the satisfactory level. Nine items from the medical students' survey showed significant positive improvements in satisfaction as the academic year increased; however, the changes were not large enough for any of the topics to receive a satisfactory score. CONCLUSION: Overall students were dissatisfied with their professionalism education. The reasons for these results and possible approaches for improving students' satisfaction should be considered in future research.

Extraintestinal Migration of Centrorhynchus sp. (Acanthocephala: Centrorhynchidae) in Experimentally Infected Rats

Reptiles were known to serve as paratenic hosts for Centrorhynchus (Acanthocephala: Centrorhynchidae) in Korea, but the infection course in experimental animals was not elucidated yet. In this study, the tiger keelback snakes (Rhabdophis tigrinus) were collected and digested with artificial pepsin solution, and the larvae of Centrorhynchus were recovered from them. Then, the collected larvae were orally infected to rats for developmental observations. In rats, all the larvae were observed outside the intestine on day 3 post-infection (PI), including the mesentery and abdominal muscles. As for the development in rats, the ovary of Centrorhynchus sp. was observed at day 15 PI, and the cement glands were 3 in number. Based on the morphological characteristics, including the arrangement of proboscis hooks, these larvae proved to be a species of Centrorhynchus, and more studies were needed for species identification.

The Examination of the Acute Vascular Changes Due to Smoking Using Second Derivative of Photoplethysmogram / 가정의학회지

BACKGROUND: Although smoking is the major risk factor for atherosclerosis under the age of 40, the smoking rate of adolescent and young adult has been is increasing. In case of young adults, there is no available clinical indices reflecting harmful effects of smoking. The aim of this study was to investigate whether any second derivative of photoplethysmogram (SDPTG) index can be used as a clinical index of acute effects of smoking. METHODS: Twenty smoking and eighteen never-smoking males ages between 20-39 without medical history of atherosclerotic disease nor peripheral vascular diseases were selected for this study. We investigated the life styles and risk factors of atherosclerosis through a questionnaire, laboratory test and physical examination. We measured SDPTG at baseline, 3, 5, 10, 15, and 20 minutes for smokers after smoking and walking and for never-smokers after walking. Repeated measures ANOVA and ANCOVA were used for analysing the changes of SDPTG according to time. RESULTS: The heart rate and blood vessel tension (BVT) were different between the smokers and never-smokers after adjusting age, fasting blood sugar, body mass index, depression, and exercise (P < 0.05, P < 0.05, respectively). In contrast to never-smokers, heart rate of smokers at 3 minutes after smoking was increased for 10.1 per minute (P < 0.001) and higher than never-smokers until 15 minutes (P < 0.05). BVT in smokers was decreased at 3 minutes (P < 0.05) from baseline and lower than never-smokers at 3 minutes (P < 0.05). Differential pulse wave index, stress power, remained blood volume, and the changes of these indices according to time were not significantly different between the two groups. CONCLUSION: BVT and heart rate reflected the acute effect of smoking on blood vessels and could be used to provide motivation to quit smoking and make people more concerned about their own health especially to the young smokers who has no symptoms yet.

The Changes in Heart Rate Variability between Morning and Afternoon

BACKGROUND: Short-term measurement of heart rate variability is known to be a non-invasive technique to examine autonomic nerve system. Heart rate variability exhibits circadian rhythm according to work/sleep cycle and biological clock. In primary practice, short-term measurement of heart rate variability is usually used during the day. Therefore the aims of this study were to investigate the possibility of differences in heart rate variability between morning and afternoon and also to examine the relationship among associated factors. METHODS: Sixty-eight healthy volunteers underwent short- term measurement of heart rate variability on two occasions: in the morning (08:30~11:00) and in the afternoon (13:30~16:00). A structured questionnaire was used to access general characteristics, emotion, fatigue and sleeping hours. RESULTS: The mean heart rate was significantly increased and SDNN, RMSSD, TP, HF and VLF were significantly decreased in the afternoon compared to the morning. LF and LF/HF were not changed. The anxiety group, the depression group and the fatigue group showed significantly greater reduction in TP and RMDDS than the control group. CONCLUSION: In the afternoon, parasympathetic activity and total power were decreased significantly compared to the morning. Short-term heart rate variability should be measured in the same time zone and need to consider food intake effect. Those who complained of anxiety, depression or fatigue were related to much decrease in TP and RMSSD in the afternoon.

Cut-off Values of Visceral Fat Area and Waist Circumference: Diagnostic Criteria for Abdominal Obesity in a Korean Population

The aim of this study was to determine the appropriate cut-off values for visceral fat area and waist circumference (WC) associated with an increase in risk for obesity-related disorder, and to validate diagnostic criteria for abdominal obesity and the metabolic syndrome in a Korean adult population. We included 413 subjects (174 men and 239 women) for this study. Subjects were selected among Korean adults who visited the obesity clinic at St. Mary's Hospital and Kangnam St. Mary's Hospital from January 1999 to August 2005. All patients had computed tomography performed. The cut-off value, of visceral fat area associated with an increase risk of obesity-related disorder, according to the receiver operating characteristics curve, was 103.8 cm2 (sensitivity 74.5%, specificity 64.7%, p<0.001). The cut-off value for the WC was 89.8 cm in men (sensitivity 84.7%, specificity 91.7%, p<0.005) and 86.1 cm in women (sensitivity 83.9%, specificity 62.9%, p<0.001). Based on the results of this study, the visceral fat area associated with an increased risk of obesity-related disorder in Korea was 103.8 cm2 and the WC was 89.8 cm in men and 86.1 cm in women.

The Effectiveness of Communication Skills of Pre-medical Students / 한국의학교육

PURPOSE: Communication skills are essential skills which medical students need to acquire in order to become a doctor. More attention is being given to the subject but not many studies have been done in the medical education field. As communication skills are provided to students as a subject in medical educational curriculum, the assessment of its effectiveness needs to be undertaken. METHODS: In the year 2005 and 2006, second year pre-medical students at The Catholic University College of Medicine took 'Communication Skills' course in total, 180 second year pre-medical students' survey results were used in the evaluation of the study question. The instrument used in the study was the modified and translated version of 'Beyer-Fetzer's Essential Elements of Communication Skills Assessment Sheet.' The assessment sheets were used as the pre-test and post-test to analyse the differences, which were put through the paired t-test. RESULTS: All categories of communication skills showed an improvement. For year 2005, meaningful differences were shown in 'opening the discussion (p=.005)' and 'sharing information (p=.008)', whereas in 2006, improvements were shown in all areas. CONCLUSION: From the result, it is clear that in order to create an effective communication skills program, the content should be more structured and focused on the program objectives.

Patient-centered Attitudes in Primary Care Patients

BACKGROUND: As the society changes to consumer-oriented trend, physician-patient relationship is in need of change. Patients tend to be highly satisfied when their physicians show more patient centered view or have similar character with their own. There have been studies on the patient-centeredness of medical students and physicians in Korea, but none was performed on the patient's patient-centeredness. The aim of this study was to investigate attitudes toward patient-centeredness and its associated factors in patients who visited local family practitioner's clinics. METHODS: The subjects were 359 patients who visited 10 local family practitioner's clinics from March 1 to July 1, 2005. Our survey utilized PPOS (Patient-Practitioner Orientation Scale) which composed of Sharing (sharing information, take part in decision making) and Caring (respecting one's feelings, interpersonal relationships) subscale. It also included demographic variables and health status by self questionnaire. Factors affecting patient-centeredness was analyzed via the t-test, ANOVA and Pearson Correlation. RESULTS: The total PPOS score was 3.85. The Sharing and Caring subscales were 3.68 and 4.02, respectively. We found that the patients, who were functionally healthier, younger than 40 years old, college-educated, and earning higher income, were significantly more patient-centered. CONCLUSION: The patients' desire to obtain medical information and to take part in decision making (Sharing) were lower than that of patients' expectations for gaining respect of one's feelings and interpersonal relationships (Caring). The patients, who were healthier, younger, more educated, and earn more income, were shown to be significantly more patient-centered.

Smoking Behavior Following Diagnosis of the Coronary Artery Disease and Factors Influencing Smoking Cessation

BACKGROUND: The success rate of smoking cessation by patients with coronary artery disease is lower than expected and reportedly this rate increases once doctors intervene. The purpose of this study is to help doctors mediate their patients to quit smoking by investigating of smoking behavior following the diagnosis of coronary artery disease and promoting methods of smoking cessation with knowledge of factors influencing smoking cessation. METHODS: A total of 245 male coronary artery disease patients confirmed by coronary angiography in two university hospitals located in Seoul participated in the survey. RESULTS: The smoking cessation rate among the subjects for more than one year was 39.6%. More than 90% of the subjects were aware of the doctors warning about smoking, but no more than 6% of them heard how to actually stop smoking from their doctors. In the smoking cessation group the stress score was lower and the exercise performance rate was higher than the smoking group. Logistic regression analysis revealed the abstinence group succeeded in smoking cessation at higher rate than the drinking group (odds ratio 0.30; 95% confidence interval 0.14 to 0.65). CONCLUSION: In recommending that a patient quit smoking, doctors should inform patients that drinking could be a detrimental factor and should promote a smoking cessation program including exercise and stress control. Doctors should educate patients that smoking cessation program will be more effective than sheer will power.

Patient-Centered Attitudes and Communication Skills in Medical Students after Clerkship / 한국의학교육

PURPOSE: Patient-centered communication is known to improve patient satisfaction, compliance, doctor-patient relationship, and health outcomes. The aim of this study is to evaluate medical students patient-centered communication skills and attitudes in medical students after their clerkship. METHODS: To evaluate medical students' communication skills, OSCE was performed on 114 fourth-year medical students who had completed their clerkship. After OSCE, we used structured questionnaires to survey the subjects in assessing attitudes toward communication skill learning and patient-centeredness. RESULTS: The accomplished frequency of patient-centered communication items were as follows: allow patient's narrative thread (88.6%), open-to-closed-ended questions (47.4%), discuss psychosocial and emotional factors (36.0%), elicit patient's concerns and perspectives (36.0%), discuss how health problem affects patient's daily life (21.9%), express empathy (14.0%), negotiate plan of action with patient (68.4%), and ask whether patient has further issues to discuss (33.3%). The students who did medical service as extracurricular activity and were confident with their communication skills performed better patient-centered interviews. There was no significant relationship between medical students' patient-centered attitudes and patientcentered OSCE scores. CONCLUSION: Having completed their clerkship, medical students were still unable to perform a good patient-centered interview. Current medical curriculum should teach medical students how to communicate in a patient-centered manner. The education method should focus on behavior change initiative.

The Survey of Family Medicine Clinical Clerkships in Medical Schools in Korea

BACKGROUND: New educational objectives and evaluation methods in Korean medical schools have been suggested recently to cope with health care related environmental changes. Current status of family medicine clinical clerkships in Korean medical schools is to be known before establishing standards. METHODS: Educational Committee of Korean Academy of Family Medicine surveyed the family medicine clerkship in Korean medical school (about educational environment, subjects and evaluation methods) using structured questionnaires by e-mail and Fax from February through March in 2004. RESULTS: Family medicine clinical clerkship was run by 25 of 41 medical schools (65.9%). Educational subject areas included communication skill, observation in hospital based ambulatory office, primary care and family medicine, medical recording, diagnosis and treatment of common problems, residential out-hospital ambulatory programs, presentation of hospital based ambulatory programs, procedure skill, lifelong heath management plan, and health promotion, in descending order. Faculties of family medicine were directly in charge of educational subjects. However, educational methods were mainly composed of lectures and indirect observation. It should be noted that concrete and precise evaluation methods in the family medicine clerkship program had been lacking due to insufficient and obscure evaluation strategies. CONCLUSION: Clerkship period, educational environment, and number of class were variable among medical schools in Korea. Educational format needs to be standardized in terms of common educational subjects such as communication skill education, patient education, and ambulatory care clerkship. More valid methods are to be introduced for family medicine clerkship evaluation.

Effects of Dietary Antioxidant Vitamins and Fiber on the Risk of Myocardial Infarction

BACKGROUND: Even though antioxidant vitamins and fiber have been hypothesized to reduce the risk of coronary heart disease, few observational studies have been done in Korea. METHODS: The study sample consisted of 102 myocardial infarction (MI) patients and 112 control subjects admitted in Medical College of Catholic University in Korea. Dietary habits and nutrient intakes were assessed by a semi-quantitative food frequency questionnaire. RESULTS: Dietary consumptions of antioxidant vitamins, such as vitamin C, vitamin A, and fiber per energy were significantly higher in the controls than in the myocardial infarction patients. Odds ratios of vitamin A, vitamin C, vitamin E and fiber in the 4th quartile compared with the 1st quartile were 0.41 (95% CI 0.18~0.90), 0.33 (95% CI 0.15~0.75), 0.89 (95% CI 0.41~1.94), 0.27 (95% CI 0.12~0.63), respectively. CONCLUSION: These findings suggest that higher intake of foods rich in antioxidant vitamins and fiber can substantially reduce the risk of MI in middle-aged men.

Association of Endothelial NO Synthase Gene Glu298Asp Polymorphism with Acute Myocardial Infarction

BACKGROUND AND OBJECT: Several studies suggest that endothelial nitric oxide synthase (eNOS) Glu298Asp polymorphism is associated with coronary heart disease. We evaluated the relation between eNOS Glu298Asp polymorphism and the risk factors for myocardial infarction. MATERIALS AND METHOD: We selected 102 acute myocardial infarction (AMI) male patients younger than 65 years old and 112 healthy men as age matched controls. The eNOS genotypes were determined from blood lymphocyte DNA samples by using PCR-RFLP method. RESULTS: There was no difference in frequency of eNOs Glu298Asp polymorphism between the AMI and control groups. eNOS Glu298Asp polymorphism was not an independent risk factor for AMI. However smoking, smoking amount, hypertension, hypercholesterolemia, high fasting sugar and low HDL-cholesterol were independent risk factors (p<0.01). Among the subjects having the eNOS GG genotype, the smokers had 3 times higher risk of AMI compared with nonsmokers (p=0.0413). Among the subjects having the eNOS TT or GT genotype, the smokers had 15 times higher risk of AMI compared with nonsmokers (p=0.0271). Among the subjects having the eNOS GG genotype, the high risk group had 21.9 times higher risk of AMI compared with the low risk group (p=0.0001). Among the subjects having eNOS TT or GT genotype, the high risk group had 31.9 times higher risk of AMI compared with the low risk group (p=0.0089). CONCLUSION: eNOS TT or GT genotype demonstrated a synergistic effect with smoking and high risk group on the risk of AMI.