A 17-year-old female presented to the gynaecology OPD with complains of primary amenorrhea, short stature and absence of secondary sexual characters. Her height was 135cm and weight of 30 kg with normal intelligence. She was born of consanguineous marriage and had normal milestones. Her siblings were normal and did not have similar complaints.On examination, her vitals were PR -66/min, BP -110/68 mm Hg; CVS, RS, CNS examination showed no significant findings. On local examination, there was no pubic hair, no axillary hair and no breast bud development. On examination of external genitalia labia majora and minora were developed but clitoris was underdeveloped. On laboratory investigations, blood routine, renal function test and thyroid function test were normal. FSH was elevated but LH was in normal range.She was referred to radiology department for Ultrasonography of abdomen which revealed horse shoe kidney with absence of uterus and ovaries. MRI abdomen and pelvis confirmed the absence of uterus and ovaries [Table /Fig-1a,b] along with the presence of horse shoe kidney [Table/ Fig-2a-c]. MRI brain was screened for any pituitary pathology in view of amenorrhea, but turned out to be normal [Table /Fig-3a,b]. With the suspicion of Turner's syndrome, karyotyping was performed which supports the diagnosis by the absence of one X chromosome (45 XO) [Table /Fig-4].Hence a diagnosis of Turner's syndrome with mullerian agenesis was made. A skeletal survey was performed as a workup for Turner's syndrome which showed positive metacarpal sign-shortening of 4 th metacarpal [Table/ Fig-5]. A 2D echo was performed to look for bicuspid aortic valve and was negative. Screening of chest for coarctation of aorta was taken which showed normal aortic knuckle and no inferior rib notching-ruling out any abnormality.Patient was counseled and was put on Estrogen therapy for the development of secondary sexual characters. DISCUSSIONDuring the first 6 weeks of development the male and female fetus is indistinguishable which demonstrates both mesonephric and para mesonephric duct. The presence of Y chromosome is associated with production of mullerian inhibiting factor [1].

The major environmental hazard in this pandemic is the unhygienic disposal of medical waste. Medical wastage is not properly managed it will become a hazard to the environment and humans. Managing medical wastage is a major issue in the city, municipalities in the aspects of the environment, and logistics. An efficient supply chain with edge computing technology is used in managing medical waste. The supply chain operations include processing of waste collection, transportation, and disposal of waste. Many research works have been applied to improve the management of wastage. The main issues in the existing techniques are ineffective and expensive and centralized edge computing which leads to failure in providing security, trustworthiness, and transparency. To overcome these issues, in this paper we implement an efficient Naive Bayes classifier algorithm and Q-Learning algorithm in decentralized edge computing technology with a binary bat optimization algorithm (NBQ-BBOA). This proposed work is used to track, detect, and manage medical waste. To minimize the transferring cost of medical wastage from various nodes, the Q-Learning algorithm is used. The accuracy obtained for the Naïve Bayes algorithm is 88%, the Q-Learning algorithm is 82% and NBQ-BBOA is 98%. The error rate of Root Mean Square Error (RMSE) and Mean Error (MAE) for the proposed work NBQ-BBOA are 0.012 and 0.045.