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Background and purpose: Recently, due to the reduction of hepatitis A in Iran there are people with low or no Hepatitis A Virus- Antibody (HAV-Ab), therefore, people at Arbaeen Pilgrimage are at risk for hepatitis A. This study aimed at examining HAV-Ab in pilgrims traveling from Mazandaran province, Iran to Karbala in 2018. Materials and methods: This cross-sectional study was performed in 200 people selected from 40,000 pilgrims in Mazandaran province. Serum samples were evaluated for presence of HAV-Ab and data for demographic characteristics and history of hepatitis A immunity were recorded. Data analysis was performed in SPSS V16. Results: The participants were 137 (68.5%) males and 63 (31.5%) females. Positive and negative HAV-Ab were seen in 156 (78%) and 44 (22%), respectively. Mean ages of people with positive and negative HAV-Ab were almost similar (50 years and 47 years, respectively). HAV-Ab status was found to be significantly associated with job (P0.05). Conclusion: Twenty-two percent of people who were travelling to Karbala had no HAV-Ab, which is significant because the risk of developing fulminant hepatitis increases in adults, therefore, vaccination of Karbala pilgrims for hepatitis A virus is suggested.

Introduction: Marcus Gunn Jaw-Winking (MGJW) synkinesis is characterized by drooping eyelid and retraction with jaw movement. MGJW is usually seen alone, although familial cases have been documented. One of the problems that may occur with MGJW is Monocular Elevation Deficiency (MED). The concomitant MGJW, congenital ptosis, and MED represent a congenital misdirection syndrome that involves oculomotor nerve. Case Presentation: In this report, we present a 13-year-old girl with MGJW with severe ptosis and concomitant MED in her left eye. A brief review was performed about this case too. Conclusions: MED and MGJW maybe two extremes of one disease, because there is of a high probability of the same inheritance in the two conditions (both are due to a gene defect). Also, in our case with more severe ptosis, MED appeared, while in her aunt with less ptosis and milder MGJW, MED was absent.