The Medical Journal of Tikrit University

Background:Preterm birth define as the birth of a fetus before 37 wks of
pregnancy (which normally last from 37- 40 weeks). Preterm birth is a great
problem. It occurs in any socio-economic level countries. It still the main cause
of perinatal disease and death.. The aim of this study is to evaluate the
frequency of preterm labor in Salahuddin general hospital.
Subjects and method:A descriptive cross sectional study involving delivered
women in Salahuddin general hospital (n=151) was conducted during
February 2018. Simple random sampling was used to choose the sample and
self-administered questionnaire to gather information about socio-economic,
demographic characteristics, health status and risk factor for preterm babies.
Results: About 35 deliveries (23.18 %) were preterm deliveries. Among
women with preterm delivery, about four women were below 18 years (44.4%)
and one woman was above 35 years (6.7%). Concerning the spacing between
the last pregnancy and the previous one, in about eight women with preterm
delivery spacing was below 2 years and it was above 5 years in one woman.
First pregnancy was reported in nine women with preterm delivery. Eleven
preterm newborns were females (31.4%) and 24 were males (68.6%). In
regard to health problems in preterm newborns, 13 newborns had respiratory
problem (37%), 4 preterm newborns had poor feeding (11%), 3 newborns had
cyanosis (9%), 2 newborns had jaundice (6%), 2 newborns (6%) had low
APGAR score, and 11 (31%) were with no detected problem. In regard to birth
weight, 18 preterm babies were with a birthweight <2500 grams.
Conclusion: 1. About 23.18% of all deliveries in Salahuddin general hospital
which were taken in the sample were preterm delivery.
2. Emergency Cesarean section delivery was the most common type of labour
in preterm delivery compared with those with full term delivery where elective
CS was more common.
3. Premature delivery is risk factor for low birth weight.

Background: Case fatality rate is the most important measure of fatal
disease severity, in which the proportion of number of people died from
certain disease compared to the total number of people diagnosed with
this disease for certain period of time. According to many reports
reaching Public Health Department in Salahiddin Health Directorate,
there was an increase in number of deaths of covid-19 cases in Samarra
General Hospital, for that reason the current study conducted to estimate
the case fatality rate of covid-19 in Samarra Hospital and to assess the
epidemiological and clinical factors affecting it.
Patients and Methods: A cross-sectional descriptive study was done
for all deaths happened in Samarra General Hospital due to covid-19 for
the period from 23/6/2020 (the first death of covid-19 in Samarra), to
12/9/2020, and the total number studied was 81 deaths. From those only
57 deaths happened inside the hospital.
The data related to epidemiological and clinical factors of those 57
deaths were collected and analyzed statistically using Microsoft Excel
2013.
Results:
The study showed that case fatality rate of covid-19 in Samarra city was
(6.6%) which is more than that of Iraq. Deaths among male was more
than female, and the larger number of deaths occur in age groups
younger than that worldwide.
Conclusion: The case fatality rate of covid-19 in Samarra city is higher
than normal in comparison with other cities. In Salahiddin, there is a
need to assess the management guidelines used in Samarra General
Hospital.

Menstruation (period) considered as major stages in puberty in girls, it
is one of many physical signs that the girls turning into women. Cross-
sectional study carried out in Tikrit University College Of Medicine
among 120(16%) female medical students during three period, 2012 as
stratified simple random sample. A certain questionnaire was given for
each students. The range of menarche that reported as common one
was between 11-13years by 66.7%(80). 89.2% (107) female students
have symptoms associated with menstrual cycle. The most disturbed
symptoms was abdominal pain by 72.9%(78). Most of these female use
analgesic to relieve symptoms by 72%(77). The highest rate for
irregular menstrual cycle reported among those from 1St stage by 26.9%
(7) and 50% (8) can't identify the regularity. The menstrual cycle
affected by stress 45.9% (55), anemia 14.2%(17) and family history
with 45.9%(55). Out of the total (107), 35.5%(38) students had school
absent, and 31.8%(34) experienced social withdrawal. Health education
on menstrual problems targeting female students and their parents , and
routine screening for menstrual problems by healthcare providers , can
help prevent the absenteeism .

Background and objectives: Vitamin D deficiency and LBP are well
documented in Kirkuk city; henceforth it would be appropriate to evaluate the
association between vitamin D deficiency and severity of low back pain.
Methods: A cross-sectional descriptive hospital based study was done in
Kirkuk general hospital, located in Kirkuk city, Iraq; during a one year period
starting from the 1st of June 2018 and ending on the 31st of June 2019. Total
of (100) patients having low back pain (LBP) were included by non-probability
consecutive sampling. Demographic information included in the questionnaire
[age, gender, body mass index (BMI), education level, marital status, and
occupation]. Patients were divided into two groups as Vitamin D deficient
(Group 1) with a Vitamin D level below 20 ng/mL and normal (Group 2) with
a value above 20 ng/ml.
Results: Hundred patients with backache participated in the study. Their mean
age + SD was 45.01 + 14.76 years. The deficiency of vitamin D was detected
in (83%) of the patients, while Vitamin D was found in (17%) as normal. No
significant association was detected between vitamin D deficiency with gender
(p = 0.110), BMI (p = 0.672), educational level (p = 0.598), and marital status
(p = 0.357); however, there was a statistically significant difference between
the two groups in terms of VAS score and levels of Vitamin (D), since the
highest mean of vit.D (27.96) was among patients with mild backache which
was significantly higher than the mean among those with severe backache
(14.27) or very severe backache (13.68).
Conclusion: Our study revealed a connection between Vitamin D deficiency
and the severity of the pain in patients with LBP. Vitamin D levels screening
in individuals with LBP should be taken into consideration because of the
cheap, safe, treatable form of the symptoms for clinicians.

Background: Pregnancy rhinitis is a relatively common condition, but it seldom
discussed in the natinal literature. it gained importance in recent years, mainly due to
the discovery of its association with snoring and obstructive sleep apnea during
pregnacy. addotionally studies have shown its association with gestational
hypertension, intrauterine growth retradation and lower apager
scores in neonates.
Objectives
 To identify the rhinitis in pregnant women according to age group
 To determine the various manifestations of rhinitis during pregnancy
Patients and methods:Across sectional study of 45 patients with symptoms of rhinitis
during pregnacy some of them refered from gynecological department and other seen
directly in ENT private clinic during five months of study extend from september
2018to feburay 2019.
Results: Half of patients were less than the age of 34 years, the most frquent
symptoms were nasal obstruction(67%) followed by rhinorrhea, sneezing and least
reported post nasal drip(20%)
Conclusions: Rhinitis during pregnancy can affect any pregnant woman and
symptoms emerging mostly in the first trimester

Background: Angel\'s trumpet plant is available and distributed widely
and cultivated as garden plant due to its beauty and less maintenance
needs. However it\'s not well known by general population that Angel\'s
trumpet is poisonous, hence poisoning by Angel\'s trumpet ingestion is
not uncommon.
Aim: The study aimed to identify patient’s presentation with Angel\'s
trumpet poisoning
Patient and Methods: The current study is case report study which
includes a 6 years old male from Alalam district in Tikrit city
presented to Salahuldin general hospital /emergency department with
anticholinergic toxicity due to ingestion of angel\'s trumpet plant.
Detailed history, clinical examinations, and full accessible
investigations were done. Hematological investigations) complete
blood count), biochemical investigations (renal function test, liver
function test, random blood sugar) and ECG. Supportive treatment as
well as neostigmine was administered.
Results: Angel\'s trumpet poisoning case with anticholinergic toxicity
symptoms and signs. After hard work up and close monitoring was
completely recovered without any residual effects.
Conclusion: Angel\'s trumpet poisoning case of 6 years old male
presented with anticholinergic signs and symptoms (loss of
consciousness, dry mucous membranes, fever, tachycardia, muscle
weakness and mydriasis .With close observation and supportive
treatment beside neostigmine as an alternative antidote the patient
respond well and discharged home without any residual effects.

A descriptive study was done to detection of viruses in blood
donors attending the blood bank center in Tikrit city . for six
month /2019.
In addition to determine some demographic factors like sex,
Age and blood group in infected cases.

Background: Styloid process is sparse bony protrusion situated
between the external and internal carotid arteries just proximal to the
internal jugular vein and facial nerve. Styloid process varies in length
from absent to elongated process and styloid process longer than 25 mm
is considered as elongated. Elongation of styloid process and
calcification of stylohyoid ligament may cause Eagle\\'s syndrome which
can be diagnosed by high resolution computerized tomography. The
most cases of Eagle\\'s syndrome are idiopathic cause; however, the first
case of Eagle\\'s syndrome was diagnosed by Dr. Watt Weems Eagle as
post tonsillectomy complication.
Aim of study: to detect the incidence of causes of Eagle\\'s syndrome in
the Iraqi society.
Material and Method: Thirty four patients with craniofacial pain,
cervical pain, chronic dysphagia, and sensation of foreign body in the
throat of both sexes aging between (10-58) years are diagnosed as
Eagle\\'s syndrome by high resolution computerized tomography.
Result: Five patients (15%) had undergone tonsillectomy, three patients
(9%) had severe head injury and two patients (6%) had difficult
prolonged dental extraction as causes of Eagle\\'s syndrome, while the
cause of Eagle\\'s syndrome in the rest of patients is unknown
(idiopathic).
Conclusion: Eagle\\'s syndrome is a very rare and oftenly missed
complication of tonsillectomy, severe head trauma and prolonged dental
extraction that should be kept in mind

Forty eight sexually matured adult female rabbits were divided into 6
groups, control, A, B, C, D and E. The experimental groups were
overictomized and scarified at the time interval of zero, 7, 14,
30,60and90 days respectively. Blood samples were collected twice, one
before the operation and the second one before scarifying. Blood
samples were centrifuged and then, serum was obtained and tested for
estrogen. Also cardiac tissue and coronary arteries were prepared and
stained with hematoxylin and eosin (H&E) method. And slides were
then examined. The results showed statistically significant difference in
estrogen level, and was declining with time after bilateral overictomy ,
and was ( 29.45 ± 0.65 ) (pg/ml)in control, while it was lower in the
other groups the difference finally group E showed widely spaced
cardiac fibers with fat deposition replacing the losted cardiomyocytes
with congested thick walled blood vessels.
The coronary artery in the control and group A showed normal
endothelial cell distribution without degenerative changes with normal
wall thickness and lumen. The endothelial cells in group B showed
minor changes, the wall thickness increased. No major changes in the
lumen, more epithelial cell distribution and irregular outline in group C
when compared to group Atheroma formation and clear atherosclerotic
changes.

BACKGROUND: Renal failure is increasing problem world wild and
dialysis through vascular access is almost always done for the patients
pending renal transplant, but a lot of complications can be caused by
different types of the vascular accesses, this study assess the quality of
vascular access in the dialysis unit in Kirkuk city.
OBJECTIVES: This study assesses the quality of different types of
vascular accesses done for the renal failure patients, success rate and
incidence of complications.
SUBJECTS AND METHODS: This is a community-based descriptive
cross-sectional study done in Kirkuk city from the period of 1st January
2016 to the 31th December 2017 in the dialysis unit of Kirkuk general
hospital in Kirkuk city, 154 patients complaining from renal failure are
involved in this study, the age ranged from (16 – 72) years old.
RUSULTS: The study has showed that infection, thrombosis and
arterial puncture were statistically significant complication associated
with double lumen catheter especially in femoral vein.
Regarding the failure of AV fistula, there was no significant association
between the site of AV fistula & its failure.
CONCLUSIONS: The study has showed that infection, thrombosis and
arterial puncture were statistically significant complication associated
with double lumen catheter especially in femoral vein. Diabetes has not
been associated with increased risk of infection with double lumen
catheter. Regarding the function of AV fistula there was no significant
association between its success and the age of the patients also there was
no significant association between the site of AV fistula & its failure

Malnutrition remains one of the most common causes of morbidity and
mortality among children through the world. Approximately 9%of children
below 5years of age suffer from wasting (weight for height below -2 standard
deviations (<-2SD) of the national center for health statistics (NCHS)/WHO
reference values) and are at risk of death or sever impairment of growth and
physiological development .Giardia lamblia and Helicobacter pylori are two
intestinal pathogens sharing the same mode of infection .They are known to
infect the gastrointestinal tract of humans early in life and to be very prevalent
in endemic areas throughout life. A case control selective study were done on
patients with malnutrition attending Salah Al-deen hospital in Tikrit city
included 100 children with malnutrition (60 males and 40 females), their age
range was 2-60 months the study also included 100 healthy children (as control
group) to evaluate the co-infection of H. pylori and G. lamblia infection
among malnourished children. Each malnourished and control group were sent
for general stool examination and for detection of Giardia lamblia trophozoite
or cyst. Stool sample also tested for detection of Helicobacter pylori antigens.
The study revealed that the frequency of G. lamblia and H. pylori in
malnourished children was 14% and 40% respectively and significantly higher
than in control group (5% and 20% respectively). The study also found that
34% of malnutrition children were infected with H. pylori , 8% were infected
with G. lamblia and 6% were coinfected with the two microorganisms. The
study showed that the highest rate of Giardia lamblia and Helecobacter pylori
infection was occurred in malnourished children within the age group 25-36
months and most of them from rural area. The present study showed that 64%
of study cases were with mild malnutrition, 22% moderate and 14% were with
severe malnutrition. The aim of this study is to evaluate the co-infection of H.
pylori and G. lamblia infection among malnutrition children in Tikrit City.
And the conclusion of the study is that the frequency of giardiasis and H. pylori
infection in malnourished cases are more than control.

background:Omphalitis defined as either pus discharge with erythema of the
abdominal skin or severe redness (>2 cm extension from the cord stump) with
or without pus (1).The study is across sectional description study would be
done on a neonate who presented with umbilical infection or discharge and
who attained the pediatric department at tikrit teaching hospital during the
period from first June to last of septemper 2017.
Aim:
1. To clarify the prevalence of umbilical infection among study neonate.
2.To identify the age,sex,residence,maturity, among the study cases.
3.To clarify the methods of diagnosis of umbilical infection.
4.To idenfy the lines of treatment among the Study cases with it's duration.
5.To evaluate the response of treatment according to differentiate lines.
6.To assess the present practices of umbilical cord care in the newborn
Patient and Methods: A prospective study done on neonate attained to
pediatric department at Tikrit teaching hospital and neonate care unit
department.
Results: two hundred neonates randomly selected and examined.The age of
neonates ranged between
(1-30 )days.The males were (59%) and females (41%) .No significant
association between neonatal sepsis and omphalitis.Only pus discharge was
significantly associated with positive blood culture (2).
Conclusion: presence of wide varieties in the methods of the umbilical
cord.Keeping umbilical cord clean seemed to be effective and clean.The
practices of cleaning care The main goals in every delivery and health
program for the umbilical cord involving the whole country. High prevalence
of omphalitis recorded in Tikrit neonatal care unit in hospital and majority of
them presented with redness and the most effective substances in prevention
and treatment.

Background: Chronic kidney disease (CKD) is increasingly recognized as global
health problem. There is evidence that CKD can be detected using simple laboratory
tests, and that treatment can prevent or delay complications of decreased kidney
function, slow the progression of kidney disease and reduce the risk of cardiovascular
disease (CVD).
Aim: The present study was conducted to evaluate the role of tumor necrosis factor α
receptor 2 (TNFR2) as a biomarker for detection of renal dysfunction.
Materials and Methods: The study was carried out for the period from February to
June 2019 and included 180 patients (their ages were between 19 and 85 years old) and
were divided into 60 patients with renal impairment, 60 hemodialysis patients, and 60
patients with normal renal function (as a control group). Each group included patients
with hypertension, patients with diabetes mellitus, and hypertensive- diabetic patients.
The patients were attended to Center of Kidney Disease and Transplantation, Dialysis
Unit of Baghdad Teaching Hospital – Medical City , Dialysis Unit of Tikrit Teaching
Hospital and private laboratory in Samarra City.
Urine sample was collected from each patient for bacteriological study and detection
the level of TNFR2.
Results: The present study revealed that only 18% of samples had positive bacterial
growth. The most common isolated bacteria were E.coli. The mean of TNFR2 was
higher in patients with renal impairment and positive urine culture than those with
negative culture. However, the difference was statistically significant. The difference
in the mean of TNFR2 between hemodialysis patients with positive urine culture and
those with negative culture was statistically non- significant. The mean of TNFR2 in
the patients with positive urine culture was higher than those with negative culture.
The difference was statistically non- significant. The difference in the mean of
TNFR2 between hypertensive patients with normal renal function (control) and
hypertensive- hemodialysis was statistically significant.
Conclusion: Level of urine TNFR2 can be used as a marker for early detection of renal
dysfunction.

Background: Schoolchildren usually use school bags to carry their
school materials. Carrying heavy school bags can cause several
problems such as musculoskeletal problems among schoolchildren. The
aim of this study was to investigate the association between the weight
of school bags and the occurrence of low back, shoulder and hand/wrist
symptoms among primary school children.
Method: This cross-sectional, descriptive- analytical study was
conducted among a sample of 500 elementary school children in
Baqubah Iraq. Data were collected using a questionnaire and from
measurement of the school bag weight, body weight, distance on foot
and any muscular pain of each participant. Data were analyzed using
SPSS software.
Results: The average load carried by schoolchildren was 4.250 kg,
representing approximately 28.4% of the children's body weight. Girls
and lower grade children carried a greater percentage of their body
weights. Approximately 83% of the children reported some kind of
musculoskeletal symptoms. The results of binary logistic regression
indicated that the school bag weight (expressed as a percentage of body
weight) was only significantly associated with shoulder/wrist symptoms
(P<0.05). Girls were more likely to complaint from low back pain than
boys were..
Conclusion: The results indicate a high prevalence of musculoskeletal
symptoms among elementary schoolchildren. Preventive measures and
appropriate guidelines with regard to safe load carriage in
schoolchildren are needed to protect this age group.

The aim of this study is to evaluate the benefit of intra articular
and intra lesional platelet-rich plasma (PRP) injections in a group
of patients clinically diagnosed with primary and secondary
osteoarthritis, athletic trauma and various tendinopathy and to
determine the response of patients in addition to number of
frequency of injections and time needed to follow up these patients.
This study was carried out among 48 patients (16 males and 32
females) from Salah Eldin city whose ages distributed between 22-
72 years with mean (47 years) attended to rehabilitation hospital
in Tikrit. All were reviewed with history, through examination and
investigation. Sample of venous blood (8ml) was aspirated and
filled in a special tube containing anticoagulant citrate with
addition of calcium chloride to concentrate platelets then
centrifuged for 15 minutes in a dedicated centrifuge speed of 2500
cycles/minute to separate platelet-rich plasma and gelatinous
material from concentrated RBCs. The result showed significant
between severity of pathology and pain relief, it was shown
relative response of mild to moderate osteoarthritis of knees,
chondrocalcinosis, tendon sprain and partial meniscus tear.
Also,this study didn’t registered any post-injection infection or
allergic reaction and discomfort subsided after three days.

Background: Malnutrition is considered the most important public health problem in
children in the developing countries and risk factor for the burden of diseases which associated
with impairment of immunity that aggravate infections including asymptomatic bacteriuria and
urinary tract infection. There was a significant association between asymptomatic bacteriuria
and the malnourished children that may have predisposed them to urinary tract infection, so
urine from all such children should be routinely screened for the presence of asymptomatic
bacteriuria and appropriate antibiotic should be given if the culture is positive.
Aim: The aim of this study is to decrease morbidity among malnourished children by early
detection of asymptomatic bacteriuria.
Pateints and methods : A cross sectional descriptive study was done on patients aged 2 months
to 5 years with malnutrition attending the rehabilitation ward and the outpatient clinic at
Salah_Aldeen General Hospital during the period from 1st of February to the last of the June
2019. The study involved 110 child who were divided into 2 groups (cases and control group).
Each case included in the study was assessed initially by a prepared questionnaire that included
name, age, sex ...etc. and presence of signs of malnutrition as where as assessed for some
anthropometric measures used in the assessment of nutritional states which include weight,
height and weight for height. Both study and control cases were sent for urinalysis, urine culture
and abdominal ultrasound.
Results : Significant asymptomatic bacteriuria was found in 65.5% of malnourished cases and
34.5% in control children. This study also showed that asymptomatic bacteriuria in
malnourished children increase in rural area was 73.9%, also increased with low educational
level of the mother. The most common age of bacteriuria was under 3 years and more common
in female, also asymptomatic bacteriuria was more common in bottle fed than breast fed. The
risk of bacteriuria not increased by severity of malnutrition. This study showed that Escherichia
coli was the most common micro-organism in both cases and control group.
Conclusion : It is concluded that asymptomatic bacteriuria is a significant problem among
malnourished patients which need early diagnosis to prevent further complications. The
malnourished patient should be routinely screened for the presence of asymptomatic bacteriuria
to decrease morbidity in these patients, also assessment, management and evaluation of urinry
tract infection is recommended, because symptoms of urinary tract infection in children often
vague and not specific

The study sample included randomly (90) women who are
suffering from urinary tract infection, divided into two groups
, the first group included (52) women who are pregnant ,
while the second group consist of (38) non pregnant women.
Those women was attending the gynacological department of
Salh Al-Din General hospital in Tikrit, for six Months from
January till June / 2019.
Sample were collected in sterile containers and then cultured
on selective media.
After incubation period, 120 bacterial isolation were
identified.
All diagnosis depending on the Microscopic and Macroscopic
characteristics
The use of a number of bacterial tests and AP120E tapes and
Aplstaph .
Escherichia coli and staphylococcus aureus were identified
with no significant differences P>0.05.
There are some causes of urinary tract infection (UTI) such
as menopause and use of diaphragm.

The aim of this study was to show the prevalence of calcium
pyrophosphate dihydrate crystals (CPPD) deposition among
patients clinically diagnosed with acute monoarticular arthritis and
to determined the difference between uric acid crystals deposition
and CPPD deposition in joints among patients with acute
monoarticular arthritis. This study was carried out among 50
patients with monoarticular arthritis includes 36 females and 14
males from salaheldin area ages were ranged between 30-80 years
with mean (55 years) attended rehabilitation hospital in Tikrit. All
were reviewed with history, thorough examination and
investigation. Aspiration of synovial fluid were collected from
patients who give informed consent aseptically into sterile plastic
tubs and examined by polarised light microscope. Also culturally
using standard techniques and tested for micro- organism. Sample
were cultured and incubated at 37C° aerobically for 24 hours. No
significant bacteria was shown. But examination under polarised
light microscope shown birefringent test weak positive with
rhomboid shape of CPPD crystals which is differ from uric acid
crystals which shown negative birefringent test and needle shaped.
Also study show 2% of patient with hyperparathyroidism on
treatment, 2% of patients with hemochromatosis.

Background : Neonatal jaundice is the most common condition of
newborn that require medical evaluation and treatment and it is one of the
main causes of parental concern and worries. It is defined as a yellowish
discoloration of skin and mucous membrane during the neonatal period.
Aim :This study aimed to evaluate the efficacy of Zinc sulfate on decreasing
the morbidity in neonates with indirect hyperbilirubinemia.
Pateint and method : A case control study was performed at Salahaldeen
general hospital. Seventy five patients with neonatal indirect
hyperbilirubinemia were selected as a (case group) who administered zinc
sulfate in a dose of 10 mg/day for two days in addition to other seventy five
patients as a (control group) without zinc therapy. Estimation of indirect
bilirubin level at admission, 12, 24, and 48 hrs. following admission and
compared with each other.
Results : The results show that the mean of indirect bilirubin level, 24 and 48
hrs. after therapy, was highly significant lower in the study group when
compared with the control group. The higher proportion of neonates who
received zinc therapy were hospitalized for 48 hours or less, with highly
significant association between receiving oral zinc therapy and the duration
of hospitalization. More than three quarters of neonates who underwent blood
exchange procedure, did not receive zinc therapy with a statistically
significant association between blood exchange and the administration of zinc
therapy.
Conclusion: Administration of 10 mg/day of zinc sulfate for two days was
significantly reduced indirect serum bilirubin level and decreased the total
needed duration for hospitalization as well as the need for blood exchange in
patients having severe neonatal indirect hyperbilirubinemia

All benign lesion infrequently occur in the tonsillar region, Heamongioma is a benign lesion of blood vessels mostly presented in the skin, but may occurred in mucus membrane, viscera and brain (1). The diagnosis based on clinical examination . Haemongioma is the commonest benign tumor of the head and neck in children(2) , but to be located in tonsillar region is very rare , which is presented in our case, no other associated skin or mucus membrane lesion . Aim : To illustrate rare case of palatine tonsil

Background: The age at menarche is amile stone,whiche is highly affected by internal & external factors. Menarche is considered as important point of sexual life of the girl.it is considered important factor indicator to the life style & risk factor influence.
Method: This observational cross sectional study was conducted among 70 girls participated, in the study at Mansour, Dora city & questionnaire was administered. Result: There is association of five important factors on the age of menarche like mother’s menarche age, socioeconomic status, type of diet(highly protein content, low protein &high vegetarian, physical stress & the interest in social media. Conclusion: There is positive association between mother menarche age & age of menarche of the girl. Also, there is positive correlation between socioeconomic status of the family& age of menarche of the girl. Early age of menarche of the girl associated with high protein diet &exposure to sexual content in visual media., Delay at age of Menarche associated with physical activity at puberty.