Telephone consultation for two-week-wait ENT and head and neck cancer referrals: initial evaluation including patient satisfaction.

OBJECTIVE: To analyse the outcomes of telephone consultation, including patient satisfaction, for two-week-wait head and neck cancer referrals. METHODS: Analysis of the data of this prospective study was centred on outcomes of the consultation, patient satisfaction and preference for telephone consultation. RESULTS: Patient satisfaction and preference for telephone consultation were influenced by patient awareness of cancer referral. When comparing the three most common presenting symptoms, patients with sore throat were more satisfied than those with neck mass. Regarding telephone consultation outcomes, patients with neck mass were less likely to be discharged and more likely to require investigations than those with sore throat or hoarseness. Patients with hoarseness more often required a face-to-face appointment. CONCLUSION: Telephone consultation might be a valid initial encounter for the majority of two-week-wait head and neck cancer referrals, especially when the referral symptoms are considered. This work shows the validity and safety of telephone consultation for two-week-wait head and neck cancer referrals.

Comparative Comprehensive Analysis on Natural Infections of Hymenolepis Diminuta and Hymenolepis Nana in Commensal Rodents.

This first comprehensive report from Punjab province of India relates to patho-physiological alterations alongwith morpho-molecular characterisation and risk assessment of natural infections of Hymenolepis diminuta and Hymenolepis nana in 291commensal rodents including house rat, Rattus rattus (n=201) and lesser bandicoot rat, Bandicota bangalensis (n=90). Small intestine of 53.61 and 64.95 % rats was found infected with H. diminuta and H. nana, respectively with a concurrent infection rate of 50.86 %. There was no association between male and female rats and H. diminuta and H. nana infections (ᵡ2 = 0.016 and 0.08, respectively, d.f.= 1, P>0.05), while the host age had significant effect on prevalence of H. diminuta and H. nana (ᵡ2 = 28.12 and 7.18, respectively, d.f.= 1, P≤0.05) infection. Examination of faecal samples and intestinal contents revealed globular shaped eggs of H. diminuta without polar filaments (76.50 ± 3.01µm x 67.62 ± 2.42 µm), while smaller sized oval eggs of H. nana were with 4 - 8 polar filaments (47.87 ± 1.95 µm x 36.12 ± 3.05 µm). Cestode infection caused enteritis, sloughing of intestinal mucosa, necrosis of villi and inflammatory reaction with infiltration of mononuclear cells in the mucosa and submucosa. Morphometric identification of the adult cestodes recovered from the intestinal lumen was confirmed by molecular characterisation based on nuclear ITS-2 loci which showed a single band of 269 bp and 242 bp for H. diminuta and H. nana, respectively. Pairwise alignment of the ITS-2 regions showed 99.46 % similarity with sequences of H. diminuta from USA and 100 % similarity with sequences of H. nana from Slovakia, Kosice.

Molecular characterization and histo-physiological alterations induced by concurrent helminthosis in the liver of urban commensal rodents in Punjab, India.

BACKGROUND: Rodents harbour a number of parasites of public health importance, thus, they threaten human health and livestock. AIMS: The present study aimed to characterize two helminthic species found in commensal rodents and record histo-physiological alterations induced by them. METHODS: A total of 300 synanthropic rodents of three species: Rattus rattus (n=201), Bandicota bengalensis (n=90), and Mus musculus ( n=09 ) were live trapped and necropsied in different seasons during November 2017 to October 2019 at Ludhiana, Punjab, India. RESULTS: Liver of two species B. bengalensis (72.22%) and R. rattus (65.67%) were found infected with two helminthic parasites Taenia taeniaeformis, and Calodium hepaticum. These endoparasites were present either alone (4.33-6.33%) or as mixed infection (65.55%). The level of total proteins and liver marker enzymes including aspartate aminotransferase (AST) and alanine aminotransferase (ALT) were found significantly higher in the liver of rodent species infected with single and mixed infection compared to those with no infection. In histopathological assay, granulomatous liver lesions and necrosis of hepatocytes were seen which were associated with eggs and adults of C. hepaticum and inflammatory reaction in hepatic parenchyma adjoining to cysts of T. taeniaeformis. Based upon scanning electron microscopy (SEM) identification and molecular characterization using mitochondrial cytochrome oxidase I (COI) region, the metacestodes in whitish cysts were confirmed to be of T. taeniaeformis for the first time in Punjab, India. CONCLUSION: The study highlights an alarmingly high infection of rodents with zoonotic parasites and suggests immediate pest (rodent) control to check the dissemination of zoonotic diseases by helminth species under study.

Germline variants and phenotypic spectrum in a Canadian cohort of individuals with diffuse gastric cancer.

Background: CDH1 pathogenic variants (pvs) cause most cases of inherited diffuse gastric cancer (dgc), but have low detection rates and vary geographically. In the present study, we examined hereditary causes of dgc in patients in Ontario. Methods: CDH1 testing through single-site or multi-gene panels was conducted for patients with dgc meeting the 2015 International Gastric Cancer Linkage Consortium (igclc) criteria, or with isolated dgc at less than 50 years of age, or with a strong family history of cancer identified at the Zane Cohen Centre (zcc). All CDH1-positive patients at zcc, regardless of cancer history, were summarized. Results: In 15 of 85 patients with dgc (17.6%), a pv or likely pv was identified through CDH1 single-site (n = 43) or multi-gene panel (n = 42) testing. The detection rate was 9.4% overall (8 of 85) and 11% using igclc criteria (7 of 65). No CDH1 pvs were identified in patients with isolated dgc at less than 40 years of age, but 1 pv was identified in a patient with isolated dgc at less than 50 years of age. Multi-gene panels identified 9 pvs (21.4%), including CDH1, STK11, ATM, BRCA2, MLH1, and MSH2. Review of 81 CDH1 carriers identified 10% with dgc (median age: 48 years; range: 38-59 years); 41% were unaffected (median age: 53 years; range: 26-89 years). Observed malignancies other than dgc or lobular breast cancer (lbc) included colorectal, gynecologic, kidney or bladder, prostate, testicular, and ductal breast cancers. Lobular-breast cancer was seen only in 3 families. Conclusions: In Ontario, the detection rate of CDH1 pvs in patients with dgc was low: no pvs were identified in patients with isolated dgc at less than 40 years of age, and 1 was identified in a patient with isolated dgc at less than 50 years of age. Isolated lbc with no dgc was observed in CDH1-positive families, as were pathology-confirmed nondgc or non-lbc malignancies, which had not previously been reported. Given a phenotype that overlaps with other hereditary conditions, multi-gene panels are recommended for all patients with dgc at less than 50 years of age and for those meeting igclc criteria.

Polymer-based or polymer-free stents in patients at high bleeding risk

BACKGROUND Polymer-free drug-coated stents provide superior clinical outcomes to bare-metal stents in patients at high bleeding risk who undergo percutaneous coronary intervention (PCI) and are treated with 1 month of dual antiplatelet therapy. Data on the use of polymer-based drug-eluting stents, as compared with polymer-free drug-coated stents, in such patients are limited. METHODS In an international, randomized, single-blind trial, we compared polymer-based zotarolimus-eluting stents with polymer-free umirolimus­coated stents in patients at high bleeding risk. After PCI, patients were treated with 1 month of dual antiplatelet therapy, followed by single antiplatelet therapy. The primary outcome was a safety composite of death from cardiac causes, myocardial infarction, or stent thrombosis at 1 year. The principal secondary outcome was target-lesion failure, an effectiveness composite of death from cardiac causes, target-vessel myocardial infarction, or clinically indicated target-lesion revascularization. Both outcomes were powered for noninferiority. RESULTS A total of 1996 patients at high bleeding risk were randomly assigned in a 1:1 ratio to receive zotarolimus-eluting stents (1003 patients) or polymer-free drugcoated stents (993 patients). At 1 year, the primary outcome was observed in 169 of 988 patients (17.1%) in the zotarolimus-eluting stent group and in 164 of 969 (16.9%) in the polymer-free drug-coated stent group (risk difference, 0.2 percentage points; upper boundary of the one-sided 97.5% confidence interval [CI], 3.5; noninferiority margin, 4.1; P=0.01 for noninferiority). The principal secondary outcome was observed in 174 patients (17.6%) in the zotarolimus-eluting stent group and in 169 (17.4%) in the polymer-free drug-coated stent group (risk difference, 0.2 percentage points; upper boundary of the one-sided 97.5% CI, 3.5; noninferiority margin, 4.4; P=0.007 for noninferiority). CONCLUSIONS Among patients at high bleeding risk who received 1 month of dual antiplatelet therapy after PCI, use of polymer-based zotarolimus-eluting stents was noninferior to use of polymer-free drug-coated stents with regard to safety and effectiveness composite outcomes. (Funded by Medtronic; ONYX ONE ClinicalTrials.gov number, NCT03344653.). (AU)

PBDE-47 and PBDE mixture (DE-71) toxicities and liver transcriptomic changes at PND 22 after in utero/postnatal exposure in the rat.

Pentabromodiphenyl ethers (PBDE) are found in human tissue, in household dust, and in the environment, and a particular concern is the potential for the induction of cancer pathways from these fat-soluble persistent organic pollutants. Only one PBDE cancer study has been conducted and that was for a PBDE mixture (DE-71). Because it is not feasible to test all PBDE congeners in the environment for cancer potential, it is important to develop a set of biological endpoints that can be used in short-term toxicity studies to predict disease outcome after long-term exposures. In this study, PBDE-47 was selected as the test PBDE congener to evaluate and compare toxicity to that of the carcinogenic PBDE mixture. The toxicities of PBDE-47 and the PBDE mixture were evaluated at PND 22 in Wistar Han rat (Crl: WI (Han)) pups after in utero/postnatal exposure (0, 0.1, 15, or 50 mg/kg; dams, GD6-21; pups, PND 12-PND 21; oral gavage daily dosing). By PND 22, PBDE-47 caused centrilobular hypertrophy and fatty change in liver, and reduced serum thyroxin (T4) levels; similar effects were also observed after PBDE mixture exposure. Transcriptomic changes in the liver included induction of cytochrome p450 transcripts and up-regulation of Nrf2 antioxidant pathway transcripts and ABC membrane transport transcripts. Decreases in other transport transcripts (ABCG5 & 8) provided a plausible mechanism for lipid accumulation, characterized by a treatment-related liver fatty change after PBDE-47 and PBDE mixture exposure. The benchmark dose calculation based on liver transcriptomic data was generally lower for PBDE-47 than for the PBDE mixture. The up-regulation of the Nrf2 antioxidant pathway and changes in metabolic transcripts after PBDE-47 and PBDE mixture exposure suggest that PBDE-47, like the PBDE mixture (NTP 2016, TR 589), could be a liver toxin/carcinogen after long-term exposure.

Outcomes by treatment modality in elderly patients with localized gastric and esophageal cancer.

Background: We aimed to assess current treatment patterns and outcomes in elderly patients with localized gastric and esophageal (ge) cancers. Methods: This retrospective analysis considered patients 75 years of age or older with ge cancers treated during 2012-2014. Patient demographics and tumour characteristics were collected. Overall survival (os) and disease-free survival were assessed by univariable and multivariable Cox proportional hazards regression, adjusting for demographics. Logistic regression analyses were used to examine factors affecting treatment choices. Results: The 110 patients in the study cohort had a median age of 81 years (range: 75-99 years). Primary disease sites were esophageal (55%) and gastric (45%). Treatment received included radiation therapy alone (29%), surgery alone (26%), surgery plus perioperative therapy (14%), chemoradiation alone (10%), and supportive care alone (14%). In multivariable analyses, surgery (hazard ratio: 0.48; 95% confidence interval: 0.26 to 0.90; p = 0.02) was the only independent predictor for improved os. Patients with a good Eastern Cooperative Oncology Group performance status (p = 0.008), gastric disease site (p = 0.02), and adenocarcinoma histology (p = 0.01) were more likely to undergo surgery. Conclusions: At our institution, few patients 75 years of age and older received multimodality therapy for localized ge cancers. Outcomes were better for patients who underwent surgery than for those who did not. To ensure optimal treatment selection, comprehensive geriatric assessment should be considered for patients 75 years of age and older with localized ge cancers.

Degradation of chlortetracycline using immobilized laccase on Polyacrylonitrile-biochar composite nanofibrous membrane.

The continuous release of antibiotic compounds through wastewater effluent into environment has raised concerns about their potential problems for different organisms. Enzymatic degradation with laccase is a green option for removal of pharmaceutical compounds from aqueous media. In this study, laccase was immobilized onto homemade Polyacrylonitrile-biochar composite nanofibrous membrane and the obtained biocatalyst was employed for removal of chlortetracycline, a widely used antibiotic, from aqueous media in continuous mode. The results showed that the immobilized laccase has improved storage, temperature and pH stability compared to free laccase. Also, it retained more than 50% of its initial activity after 7cycles of ABTS oxidation which indicated improved enzyme reusability. Finally, while using immobilized laccase for degradation of chlortetracycline in continuous mode exhibited 58.3%, 40.7% and 22.6% chlortetracycline removal efficiency at flux rates of 1, 2 and 3mL/h∙cm2.

Effect of bioavailability on the fate of hydrophobic organic compounds and metal in treatment of young landfill leachate by membrane bioreactor.

Complex dissolved organic matter (DOM) present in landfill leachate provides reliable media for adsorption of highly hydrophobic contaminants, such as Di 2-ethyl hexyl phthalate (DEHP). In this research, the feasibility of submerged membrane bioreactor (SMBR) for treatment of landfill leachate (LFL) was determined. Later, the operating conditions were optimized for removal of DEHP, COD, NH4(+) and PO4(3-), and finally the effect of bioavailability was examined by introduction of different concentrations of humic acid into the influent. The result revealed that presence of complex agglomerated organic compounds increased the removal efficiency of DEHP and COD, even though DEHP biodegradation rate in sludge dramatically decreased (from 58.8% to 12.8%). MBR retention of different metals in the absence and in the presence of recalcitrant DOM was also studied. Like DEHP, ternary interaction between metals, DOM, and sludge play a pivotal role in their removal efficiency and their concentration in sludge.

Adsorption study of environmentally relevant concentrations of chlortetracycline on pinewood biochar.

The presence of pharmaceutically active compounds (PhACs) in water and wastewater has raised concerns because of potential environmental impacts and thus their removal is of high importance. The adsorption behavior of chlortetracycline (CTC) from aqueous solution on raw and activated pinewood biochar was studied at 298 K. The effect of initial pH of the solution was studied by performing the experiment at three different pHs (1, 5 and 9). At each pH, CTC showed varied electrostatic charge (+1, 0 and -1, respectively) which affected its adsorption. The results indicated that CTC followed Langmuir isotherm and the related parameters were calculated. Also, it was observed that the maximum adsorption occurred at pH1. The adsorption capacity of CTC for raw and activated biochar was at least 2.1 and 208.3mg/g adsorbent, respectively. The characteristics of biochars were studied using zeta potential analyzer, laser size analyzer and scanning electron microscopy (SEM). The results showed that raw and activated biochars are promising candidates for removal of CTC from water due to the acidic character of pinewood that can result in better interaction with ionizable compounds at lower pHs.

Value-added performance of processed cardboard and farm breeding compost by pyrolysis.

This study aims to underline the huge potential in Canada of adding value to cardboard and compost as a renewable fuel with a low ecological footprint. The slow pyrolysis process of lined cardboard and compost blend was investigated. Thermal behavior was investigated by thermogravimetric analysis coupled with mass spectrometry (TGA-MS). The thermal profiles are presented in the form of TGA/DTG curves. With a constant heating rate of 10 °C/min, two parameters, temperature and time were varied. Cardboard decomposition occurred mostly between 203 °C and 436 °C, where 77% of the sample weight was decomposed. Compost blend decomposition occurred mostly between 209 °C and 373 °C, with 23% of weight. The principal gaseous products that evolved during the pyrolysis were H2O, CO and CO2. As a result, slow pyrolysis led to the formation of biochar. High yield of biochar from cardboard was found at 250 °C for a duration of 60 min (87.5%) while the biochar yield from the compost blend was maintained constant at about 31%. Finally, kinetic parameters and a statistical analysis for the pyrolysis process of the cardboard and compost samples have been investigated. Both materials showed a favorable thermochemical behavior. However, unlike cardboard, compost pyrolysis does not seem a promising process because of the low superior calorific and biochar values.

Occurrence, fate and effects of Di (2-ethylhexyl) Phthalate in wastewater treatment plants: a review.

Phthalates, such as Di (2-ethylhexyl) Phthalate (DEHP) are compounds extensively used as plasticizer for long time around the world. Due to the extensive usage, DEHP is found in many surface waters (0.013-18.5 µg/L), wastewaters (0.716-122 µg/L), landfill leachate (88-460 µg/L), sludge (12-1250 mg/kg), soil (2-10 mg/kg). DEHP is persistent in the environment and the toxicity of the byproducts resulting from the degradation of DEHP sometime exacerbates the parent compound toxicity. Water/Wastewater treatment processes might play a key role in delivering safe, reliable supplies of water to households, industry and in safeguarding the quality of water in rivers, lakes and aquifers. This review addresses state of knowledge concerning the worldwide production, occurrence, fate and effects of DEHP in the environment. Moreover, the fate and behavior of DEHP in various treatment processes, including biological, physicochemical and advanced processes are reviewed and comparison (qualitative and quantitative) has been done between the processes. The trends and perspectives for treatment of wastewaters contaminated by DEHP are also analyzed in this review.

Photocatalytic degradation of carbamazepine in wastewater by using a new class of whey-stabilized nanocrystalline TiO2 and ZnO.

Nanoscale photocatalysts have attracted much attention due to their high surface area to volume ratios. However, due to extremely high reactivity, TiO2 and ZnO nanoparticles prepared using different methods tend to either react with surrounding media or agglomerate, resulting in the formation of much larger flocs and significant loss in reactivity. This work investigates the photocatalytic degradation of carbamazepine (CBZ), a persistent pharmaceutical compound from wastewater (WW) using TiO2 and ZnO nanoparticles prepared in the presence of a water-soluble whey powder as stabilizer. The TiO2 and ZnO nanoparticles prepared in the presence of whey stabilizer displayed much less agglomeration and greater degradation power than those prepared without a stabilizer. Higher photocatalytic degradation of carbamazepine was observed (100%) by using whey stabilized TiO2 nanoparticles with 55 min irradiation time as compared to ZnO nanoparticles (92%). The higher degradation of CBZ in wastewater by using TiO2 nanoparticles as compared to ZnO nanoparticles was due to formation of higher photo-generated holes with high oxidizing power of TiO2. The photocatalytic capacity of ZnO anticipated as similar to that of TiO2 as it has the same band gap energy (3.2 eV) as TiO2. However, in the case of ZnO, photocorrosion frequently occurs with the illumination of UV light and this phenomenon is considered as one of the main reasons for the decrease of ZnO photocatalytic activity in aqueous solutions. Further, the estrogenic activity of photocatalyzed WW sample with CBZ and its by-products was carried out by yeast estrogen screen (YES) assay method. Based upon the YES test results, none of the samples showed estrogenic activity.

Analysis and advanced oxidation treatment of a persistent pharmaceutical compound in wastewater and wastewater sludge-carbamazepine.

Pharmaceutically active compounds (PhACs) are considered as emerging environmental problem due to their continuous input and persistence to the aquatic ecosystem even at low concentrations. Among them, carbamazepine (CBZ) has been detected at the highest frequency, which ends up in aquatic systems via wastewater treatment plants (WWTPs) among other sources. The identification and quantification of CBZ in wastewater (WW) and wastewater sludge (WWS) is of major interest to assess the toxicity of treated effluent discharged into the environment. Furthermore, WWS has been subjected for re-use either in agricultural application or for the production of value-added products through the route of bioconversion. However, this field application is disputable due to the presence of these organic compounds and in order to protect the ecosystem or end users, data concerning the concentration, fate, behavior as well as the perspective of simultaneous degradation of these compounds is urgently necessary. Many treatment technologies, including advanced oxidation processes (AOPs) have been developed in order to degrade CBZ in WW and WWS. AOPs are technologies based on the intermediacy of hydroxyl and other radicals to oxidize recalcitrant, toxic and non-biodegradable compounds to various by-products and eventually to inert end products. The purpose of this review is to provide information on persistent pharmaceutical compound, carbamazepine, its ecological effects and removal during various AOPs of WW and WWS. This review also reports the different analytical methods available for quantification of CBZ in different contaminated media including WW and WWS.

Di 2-ethylhexylphtalate in the aquatic and terrestrial environment: a critical review.

Phthalates are being increasingly used as softeners-plasticizers to improve the plasticity and the flexibility of materials. Amongst the different plasticizers used, more attention is paid to di (2-ethylhexylphtalate) (DEHP), one of the most representative compounds as it exhibits predominant effects on environment and human health. Meanwhile, several questions related to its sources; toxicity, distribution and fate still remain unanswered. Most of the evidence until date suggests that DEHP is an omnipresent compound found in different ecological compartments and its higher hydrophobicity and low volatility have resulted in significant adsorption to solids matrix. In fact, there are important issues to be addressed with regard to the toxicity of this compound in both animals and humans, its behavior in different ecological systems, and the transformation products generated during different biological or advanced chemical treatments. This article presents detailed review of existing treatment schemes, research gaps and future trends related to DEHP.

A comparative study of ultrasonication, Fenton's oxidation and ferro-sonication treatment for degradation of carbamazepine from wastewater and toxicity test by Yeast Estrogen Screen (YES) assay.

A comparative study of ultrasonication (US), Fenton's oxidation (FO) and ferro-sonication (FS) (combination of ultrasonication and Fenton's oxidation) advanced oxidation processes (AOPs) for degradation of carbamazepine (CBZ) from wastewater (WW) is reported for the first time. CBZ is a worldwide used antiepileptic drug, found as a persistent emerging contaminant in many wastewater treatment plants (WWTPs) effluents and other aquatic environments. The oxidation treatments of WW caused an effective removal of the drug. Among the various US, FO and FS pre-treatments carried out, higher soluble chemical oxygen demand (SCOD) and soluble organic carbon (SOC) increment (63 to 86% and 21 to 34%, respectively) was observed during FO pre-treatment process, resulting in higher removal of CBZ (84 to 100%) from WW. Furthermore, analysis of by-products formed during US, FO and FS pre-treatment in WW was carried out by using laser diode thermal desorption-atmospheric pressure chemical ionization (LDTD-APCI) coupled to tandem mass spectrometry (MS/MS). LDTD-APCI-MS/MS analysis indicated formation of two by-products, such as epoxycarbamazepine and hydroxycarbamazepine due to the reaction of hydroxyl radicals (OH) with CBZ during the three types of pre-treatment processes. In addition, the estrogenic activity of US, FO and FS pre-treated sample with CBZ and its by-products was carried out by Yeast Estrogen Screen (YES) assay method. Based upon the YES test results, none of the pre-treated samples showed estrogenic activity.

Carbamazepine in municipal wastewater and wastewater sludge: ultrafast quantification by laser diode thermal desorption-atmospheric pressure chemical ionization coupled with tandem mass spectrometry.

In this study, the distribution of the anti-epileptic drug carbamazepine (CBZ) in wastewater (WW) and aqueous and solid phases of wastewater sludge (WWS) was carried out. A rapid and reliable method enabling high-throughput sample analysis for quicker data generation, detection, and monitoring of CBZ in WW and WWS was developed and validated. The ultrafast method (15s per sample) is based on the laser diode thermal desorption-atmospheric pressure chemical ionization (LDTD-APCI) coupled to tandem mass spectrometry (MS/MS). The optimization of instrumental parameters and method application for environmental analysis are presented. The performance of the novel method was evaluated by estimation of extraction recovery, linearity, precision and detection limit. The method detection limits was 12 ng L(-1) in WW and 3.4 ng g(-1) in WWS. The intra- and inter-day precisions were 8% and 11% in WW and 6% and 9% in WWS, respectively. Furthermore, three extraction methods, ultrasonic extraction (USE), microwave-assisted extraction (MAE) and accelerated solvent extraction (ASE) with three different solvent condition such as methanol, acetone and acetonitrile:ethyle acetate (5:1, v/v) were compared on the basis of procedural blank and method recovery. Overall, ASE showed the best extraction efficiency with methanol as compared to USE and MAE. Furthermore, the quantification of CBZ in WW and WWS samples showed the presence of contaminant in all stages of the treatment plant.

Sewage treatment in integrated system of UASB reactor and duckweed pond and reuse for aquaculture.

The performance of a laboratory-scale upflow anaerobic sludge blanket (UASB) reactor and a duckweed pond containing Lemna gibba was investigated for suitability for treating effluent for use in aquaculture. While treating low-strength sewage having a chemical oxygen demand (COD) of typically less than 200 mg/L, with an increase in hydraulic retention time (HRT) from 10.04 to 33.49 h, COD removal efficiency of the UASB reactor decreased owing to a decrease in organic loading rate (OLR) causing poor mixing in the reactor. However, even at the lower OLR (0.475 kg COD/(m3 x d)), the UASB reactor gave a removal efficiency of 68% for COD and 74% for biochemical oxygen demand (BOD). The maximum COD, BOD, ammonia-nitrogen and phosphate removal efficiencies of the duckweed pond were 40.77%, 38.01%, 61.87% and 88.57%, respectively. Decreasing the OLR by increasing the HRT resulted in an increase in efficiency of the duckweed pond for removal of ammonia-nitrogen and phosphate. The OLR of 0.005 kg COD/(m2 x d) and HRT of 108 h in the duckweed pond satisfied aquaculture quality requirements. A specific growth rate of 0.23% was observed for tilapia fish fed with duckweed harvested from the duckweed pond. The economic analysis proved that it was beneficial to use the integrated system of a UASB reactor and a duckweed pond for treatment of sewage.