h i g h l i g h t s These guidelines provide orientation to perform clinical neurophysiological studies during COVID-19 pandemic. Guide to perform protective procedures for healthcare personal doing clinical neurophysiological studies. Offer a protocol for the disinfection of equipment and supplies in clinical neurophysiological studies.

There are different points of view regarding the origin of ethical decision-making. From a simplistic point of view, one can think that only the neurobiological characteristics of each person influence the functioning of morality. However, it is important to think about the sociocultural environment in which the person develops, including religion and psychological aspects not defined by the neurobiology that eventually determines the ethical decision-making pattern, and therefore each person's morality. The origin of ethics and human morality takes place in various elements. Correct neurological functioning, cultural characteristics, spirituality, socio-economic environment, and life experiences are essential elements that determine the development of a moral judgment. All these elements provide the brain with characteristics that determine its functioning when making decisions to resolve dilemmas and further determine the pattern of moral positions. This article seeks to expose the different factors that constitute human morality, in order to analyze each one in detail for the further understanding of the origin and complexity of morals and ethics.

Introduction: Intraoperative neurophysiological monitoring (IONM) is widely used to prevent nervous system injury during surgeries in elderly patients. However, there are no studies that describe the characteristics and changes in neurophysiological tests during the IONM of patients aged 60 years and older. The study aims to describe and compare IONM changes during surgeries in adult patients aged 18 to 59 years with those aged 60 years and older.Methods: We performed a comparative retrospective study of patients aged 18 to 59 years versus those 60 aged years and older who underwent IONM during 2013 to 2018 in Mexico City. Sociodemographic characteristics were recorded and compared. Intraoperative neurophysiological monitoring techniques, their changes, and surgical procedures for both groups were analyzed and compared using descriptive statistics, Mann-Whitney U, Fisher, and x 2 tests. The sensitivity, specificity, and positive and negative predictive values were calculated.Results: In total, 195 patients were analyzed: 104 patients, 68.63 6 6.54 years old (elderly group) and 91 patients, 42.3 6 10.5 years old (younger group). No differences were found in the rates of signal change during IONM between the group of elderly patients and the younger group. The sensitivity, specificity, and positive and negative predictive values were 80%, 99%, 80%, and 99%, respectively.Conclusions: Elderly patients have a similar rate of changes in IONM signals compared with younger patients during heterogeneous surgeries guided by IONM.